Provider Demographics
NPI:1720048135
Name:MICHELS, ANDREW D (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:MICHELS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 875
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-0875
Mailing Address - Country:US
Mailing Address - Phone:336-644-0201
Mailing Address - Fax:336-644-0501
Practice Address - Street 1:2205 OAK RIDGE RD
Practice Address - Street 2:SUITE FF
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-8728
Practice Address - Country:US
Practice Address - Phone:336-644-0201
Practice Address - Fax:336-644-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2008-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2503882AMedicare PIN