Provider Demographics
NPI:1396941183
Name:FELDHAUS, MICHELLE R (MSPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:FELDHAUS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:VOLMERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:12421 SAN JOSE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-8662
Mailing Address - Country:US
Mailing Address - Phone:904-292-0195
Mailing Address - Fax:904-292-0566
Practice Address - Street 1:12421 SAN JOSE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-292-0195
Practice Address - Fax:904-292-0566
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012134225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO296190YM65Medicare PIN