Provider Demographics
NPI:1952629560
Name:COHEN, MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COHEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17609 VENTURA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3858
Mailing Address - Country:US
Mailing Address - Phone:818-530-5156
Mailing Address - Fax:818-501-8325
Practice Address - Street 1:17609 VENTURA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3858
Practice Address - Country:US
Practice Address - Phone:818-530-5156
Practice Address - Fax:818-501-8325
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist