Provider Demographics
NPI:1831395318
Name:BARBARE, MICHELLE (MPT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:BARBARE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4911 YARMOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6293
Mailing Address - Country:US
Mailing Address - Phone:410-730-4602
Mailing Address - Fax:301-490-7860
Practice Address - Street 1:14201 LAUREL PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-497-2385
Practice Address - Fax:301-490-7860
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT6004225100000X
MD22259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist