Healthcare Provider Details

I. General information

NPI: 1528080058
Provider Name (Legal Business Name): MICHELLE A CLEARY PHD, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORIDA INTERNATIONAL UNIVERSITY 11200 SW 8TH ST ZEB 251A UP, DEPT OF HPER
MIAMI FL
33199-0001
US

IV. Provider business mailing address

FLORIDA INTERNATIONAL UNIVERSITY 11200 SW 8TH ST ZEB 251A UP, DEPT OF HPER
MIAMI FL
33199-0001
US

V. Phone/Fax

Practice location:
  • Phone: 305-348-6335
  • Fax:
Mailing address:
  • Phone: 305-348-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 1650
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: