Provider Demographics
NPI:1669784799
Name:CRANE, MICHELLE R (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:CRANE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:R
Other - Last Name:ROBBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20994 REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5918
Mailing Address - Country:US
Mailing Address - Phone:510-885-9840
Mailing Address - Fax:510-885-1537
Practice Address - Street 1:20994 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5918
Practice Address - Country:US
Practice Address - Phone:510-885-9840
Practice Address - Fax:510-885-1537
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8352225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant