Provider Demographics
NPI:1295340818
Name:HAUGHN, MICHELLE RENEE (PTA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:RENEE
Last Name:HAUGHN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 S BURLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-9646
Mailing Address - Country:US
Mailing Address - Phone:765-702-0795
Mailing Address - Fax:
Practice Address - Street 1:8109 S BURLINGTON DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-9646
Practice Address - Country:US
Practice Address - Phone:765-702-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06005777A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant