MEDICARE: MICHELLE PRESTON-SMITH P.T., D.P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT15272	CA

General Provider Information

NPI Number	:	1821013897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE PRESTON-SMITH P.T., D.P.T.

Provider Business Mailing Address
First Line	:	1518 COFFEE RD STE I
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-3164
Country	:	US
Telephone Number	:	209-576-0888
Fax Number	:	209-576-0913

Provider Business Practice Location Address
First Line	:	3184 COLLINS DR
Second Line	:
City	:	MERCED
State	:	CA
Zip	:	95348-3132
Country	:	US
Telephone Number	:	209-230-5289
Fax Number	:	209-222-6185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/13/2020

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