Provider Demographics
NPI:1942410931
Name:TERRELL, MICHELLE (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2339 ELDERWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:MI
Mailing Address - Zip Code:49544-1711
Mailing Address - Country:US
Mailing Address - Phone:616-785-8535
Mailing Address - Fax:616-785-1201
Practice Address - Street 1:1550 THREE MILE RD NW SUITE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544
Practice Address - Country:US
Practice Address - Phone:616-785-8535
Practice Address - Fax:616-785-1201
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501011156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist