Healthcare Provider Details

I. General information

NPI: 1376498162
Provider Name (Legal Business Name): MICHAEL MICHAUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 CELANESE RD STE 102
ROCK HILL SC
29732-1731
US

IV. Provider business mailing address

350 GINSBERG RD
ROCK HILL SC
29732-3628
US

V. Phone/Fax

Practice location:
  • Phone: 803-670-3067
  • Fax:
Mailing address:
  • Phone: 561-308-4388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4912
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: