Provider Demographics
NPI:1255329934
Name:CAMARATA, MICHELLE LOUISE (MHA MDT PT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LOUISE
Last Name:CAMARATA
Suffix:
Gender:F
Credentials:MHA MDT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:866-518-0283
Mailing Address - Fax:
Practice Address - Street 1:540 W CROSSVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7524
Practice Address - Country:US
Practice Address - Phone:678-585-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4225225100000X
VA2305206791225100000X
GAPT002364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT5563079OtherAETNA
CT080004225CT07OtherBLUE CROSS BLUE SHIELD
VA1255329934OtherNPI