Provider Demographics
NPI:1649521865
Name:LEROY, MICHELE LYNN (PTA, RN)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:LEROY
Suffix:
Gender:F
Credentials:PTA, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 CERES AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-7819
Mailing Address - Country:US
Mailing Address - Phone:530-521-4032
Mailing Address - Fax:
Practice Address - Street 1:2793 CERES AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7819
Practice Address - Country:US
Practice Address - Phone:530-521-4032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 4104225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant