=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184903684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE RENEE TYRRELL UNGER MS, PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2011
-----------------------------------------------------
Last Update Date | 08/15/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 LOS GATOS SARATOGA RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95030-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-402-3228
-----------------------------------------------------
Fax | 408-608-1970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 LOS GATOS SARATOGA RD
-----------------------------------------------------
City | LOS GATOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95030-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-402-3228
-----------------------------------------------------
Fax | 408-608-1970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 27383
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------