Healthcare Provider Details

I. General information

NPI: 1255808267
Provider Name (Legal Business Name): MICHELLE MARIE CHERNE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 POWELL DR
DUNDEE MI
48131-8644
US

IV. Provider business mailing address

1712 WIND DANCER TRL
TECUMSEH MI
49286-7748
US

V. Phone/Fax

Practice location:
  • Phone: 517-266-1481
  • Fax:
Mailing address:
  • Phone: 517-423-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTL0005190
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015031
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007576
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: