Provider Demographics
NPI:1205021177
Name:AGUADO, MICHELE RENEE (BS PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:RENEE
Last Name:AGUADO
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4034 LYMAN DR
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-2108
Mailing Address - Country:US
Mailing Address - Phone:215-637-8249
Mailing Address - Fax:
Practice Address - Street 1:305 CHERRY ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19106-1803
Practice Address - Country:US
Practice Address - Phone:800-974-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006695L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist