=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225227895
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TERI J MICHEL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2007
-----------------------------------------------------
Last Update Date | 06/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6083 MERRILL ST
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34287-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-240-6134
-----------------------------------------------------
Fax | 941-240-6134
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6083 MERRILL ST
-----------------------------------------------------
City | NORTH PORT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34287-2049
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-240-6134
-----------------------------------------------------
Fax | 941-240-6134
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | TERI J MICHEL
-----------------------------------------------------
Credential | LMT, CAHE
-----------------------------------------------------
Telephone | 941-240-6134
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | MM18627
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------