Provider Demographics
NPI:1932315587
Name:LOLLAR, MICHELLE SHORT (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:SHORT
Last Name:LOLLAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11884 PADGETT SWITCH RD
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:AL
Mailing Address - Zip Code:36544-4106
Mailing Address - Country:US
Mailing Address - Phone:251-343-9600
Mailing Address - Fax:251-380-3328
Practice Address - Street 1:1515 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2958
Practice Address - Country:US
Practice Address - Phone:251-343-9600
Practice Address - Fax:251-380-3328
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1596OtherSTATE LICENSE