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General NPI Number Information
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NPI Number | 1033619382
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Entity Type | Individual
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Provider Name | MICHELLE VAN ZELST PTA
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Gender | Female
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Dates
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Enumeration Date | 02/13/2018
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 1361 SARA WAY SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-0999
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Country | US
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Telephone | 505-377-3841
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Fax | 505-891-7811
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Provider Business Mailing Address
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Address Line | 1361 SARA WAY SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-0999
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Country | US
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Telephone | 505-377-3841
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Fax | 505-891-7811
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A1331
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License Number State | NM
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