Healthcare Provider Details

I. General information

NPI: 1699228783
Provider Name (Legal Business Name): MICHELE PELLAR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2016
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 SAN JACINTO BLVD
DENTON TX
76205-7535
US

IV. Provider business mailing address

4645 DWARF NETTLE DR
FORT WORTH TX
76244-6413
US

V. Phone/Fax

Practice location:
  • Phone: 940-380-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1240115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: