Healthcare Provider Details

I. General information

NPI: 1659538718
Provider Name (Legal Business Name): MICHELE ROONEY MS, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE ROONEY HARRIMAN MS, PT

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12460 CAMINITO MIRA DEL MAR
SAN DIEGO CA
92130-2368
US

IV. Provider business mailing address

12460 CAMINITO MIRA DEL MAR
SAN DIEGO CA
92130-2368
US

V. Phone/Fax

Practice location:
  • Phone: 619-804-1630
  • Fax: 858-217-4139
Mailing address:
  • Phone: 619-804-1630
  • Fax: 858-217-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: