Healthcare Provider Details

I. General information

NPI: 1275936775
Provider Name (Legal Business Name): MICHELLE DEUTSCH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE E BENTZ

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 S ALABAMA ST STE 200
INDIANAPOLIS IN
46225-3301
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-528-2489
  • Fax: 317-528-3771
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05012109A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014988
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: