Provider Demographics
NPI:1962468272
Name:TSIROVASILES, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:TSIROVASILES
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 1:84 GLASTONBURY BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4468
Mailing Address - Country:US
Mailing Address - Phone:860-633-6292
Mailing Address - Fax:860-633-6299
Practice Address - Street 1:84 GLASTONBURY BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4468
Practice Address - Country:US
Practice Address - Phone:860-633-6292
Practice Address - Fax:860-633-6299
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist