Provider Demographics
NPI:1295165231
Name:ANDERSEN, MICHELLE DARLENE (DPT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DARLENE
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 PASEO DEL REY
Mailing Address - Street 2:#208
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-8374
Mailing Address - Country:US
Mailing Address - Phone:503-522-1442
Mailing Address - Fax:
Practice Address - Street 1:9333 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist