Provider Demographics
NPI:1184760415
Name:WORTHINGTON, MICHELLE NORMAND (MPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NORMAND
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:NORMAND
Other - Last Name:WORTHINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:4522 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-6939
Mailing Address - Country:US
Mailing Address - Phone:225-924-6116
Mailing Address - Fax:
Practice Address - Street 1:4522 CHELSEA DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-6939
Practice Address - Country:US
Practice Address - Phone:225-924-6116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04938225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist