Healthcare Provider Details

I. General information

NPI: 1659688737
Provider Name (Legal Business Name): MICHELLE CACCIAPAGLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4423 SHADOWDALE DR
HOUSTON TX
77041-8718
US

IV. Provider business mailing address

8038 BROADWAY ST APT 106G
SAN ANTONIO TX
78209-2697
US

V. Phone/Fax

Practice location:
  • Phone: 713-466-6872
  • Fax:
Mailing address:
  • Phone: 225-226-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1204663
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1204663
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: