Provider Demographics
NPI:1265158398
Name:ST MICHAEL THERAPEUTICS LLC
Entity type:Organization
Organization Name:ST MICHAEL THERAPEUTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROCHIELLE
Authorized Official - Middle Name:SAKAMOTO
Authorized Official - Last Name:GUANLAO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:732-328-0787
Mailing Address - Street 1:31 MICHAEL ST
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-6074
Mailing Address - Country:US
Mailing Address - Phone:732-328-0787
Mailing Address - Fax:732-369-6365
Practice Address - Street 1:31 MICHAEL ST
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-6074
Practice Address - Country:US
Practice Address - Phone:732-328-0787
Practice Address - Fax:732-369-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy