Provider Demographics
NPI:1134345655
Name:MICHAELS, ELAINE WANG (DPT, MSPT)
Entity type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:WANG
Last Name:MICHAELS
Suffix:
Gender:F
Credentials:DPT, MSPT
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2032 LONDONDERRY DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3026
Mailing Address - Country:US
Mailing Address - Phone:972-529-8753
Mailing Address - Fax:
Practice Address - Street 1:915 W EXCHANGE PKWY
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7017
Practice Address - Country:US
Practice Address - Phone:214-383-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023919225100000X
TX1194087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist