Healthcare Provider Details

I. General information

NPI: 1487580056
Provider Name (Legal Business Name): MICHELLE CARREON PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19325 SHERMAN WAY
RESEDA CA
91335-3557
US

IV. Provider business mailing address

12411 OSBORNE ST UNIT 53
PACOIMA CA
91331-2070
US

V. Phone/Fax

Practice location:
  • Phone: 818-885-6200
  • Fax: 818-885-6200
Mailing address:
  • Phone: 818-987-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number309209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: