Provider Demographics
NPI:1972508380
Name:SIERRA, MICHELLE E (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:SIERRA
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 1:653 MYRTLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433
Mailing Address - Country:US
Mailing Address - Phone:985-893-4700
Mailing Address - Fax:985-893-3211
Practice Address - Street 1:653 MYRTLE DRIVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-893-4700
Practice Address - Fax:985-893-3211
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2018-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02679225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA535-67-3751AOtherBLUE CROSS BLUE SHIELD
LA5211614OtherAETNA PROVIDER NUMBER