Healthcare Provider Details

I. General information

NPI: 1003141433
Provider Name (Legal Business Name): MICHELLE RENAE TRICE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2009
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 W THUNDERBIRD RD
GLENDALE AZ
85306-4002
US

IV. Provider business mailing address

21299 N 91ST DR
PEORIA AZ
85382-5351
US

V. Phone/Fax

Practice location:
  • Phone: 623-486-6077
  • Fax:
Mailing address:
  • Phone: 480-381-0220
  • Fax: 623-594-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8684
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: