Healthcare Provider Details

I. General information

NPI: 1538137781
Provider Name (Legal Business Name): MICHELLE LOUISE SAPSARA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17796 SW 2ND ST
PEMBROKE PINES FL
33029-3923
US

IV. Provider business mailing address

17016 NW 22ND ST
PEMBROKE PINES FL
33028-2046
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT19850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: