Healthcare Provider Details

I. General information

NPI: 1750852828
Provider Name (Legal Business Name): MICHELLE SKINNER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34505 W 12 MILE RD STE 100
FARMINGTON HILLS MI
48331-3287
US

IV. Provider business mailing address

3618 NOBLE DR
DEXTER MI
48130-9202
US

V. Phone/Fax

Practice location:
  • Phone: 734-343-7500
  • Fax:
Mailing address:
  • Phone: 734-645-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501006219
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: