MEDICARE: ANDREW D MICHELS PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	3679	NC

General Provider Information

NPI Number	:	1720048135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW D MICHELS PT

Provider Business Mailing Address
First Line	:	PO BOX 875
Second Line	:
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-0875
Country	:	US
Telephone Number	:	336-644-0201
Fax Number	:	336-644-0501

Provider Business Practice Location Address
First Line	:	2205 OAK RIDGE RD
Second Line	:	SUITE FF
City	:	OAK RIDGE
State	:	NC
Zip	:	27310-8728
Country	:	US
Telephone Number	:	336-644-0201
Fax Number	:	336-644-0501

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/10/2008

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