Provider Demographics
NPI:1982149506
Name:ST MICHAEL THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:ST MICHAEL THERAPY SERVICES PLLC
Other - Org Name:ST MICHAEL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:956-277-0401
Mailing Address - Street 1:13892 E BUSINESS 83 # 20
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-4239
Mailing Address - Country:US
Mailing Address - Phone:956-277-0401
Mailing Address - Fax:956-277-0467
Practice Address - Street 1:13892 E BUSINESS 83 # 20
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-4239
Practice Address - Country:US
Practice Address - Phone:956-277-0401
Practice Address - Fax:956-277-0467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty