Healthcare Provider Details

I. General information

NPI: 1992244941
Provider Name (Legal Business Name): MICHELLE SENTINELLA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 02/23/2023
Certification Date: 02/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 NM 528 NW STE 106A
ALBUQUERQUE NM
87114-7025
US

IV. Provider business mailing address

187 SOUTHWOOD RD
PASADENA MD
21122-4528
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7810
  • Fax:
Mailing address:
  • Phone: 443-742-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4740
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: