MEDICARE: MICHAELLA MARIE ANGE CORMIER PT, DPT

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	208100000X	Physical Medicine & Rehabilitation Physician	08480	LA

General Provider Information

NPI Number	:	1891039053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELLA MARIE ANGE CORMIER PT, DPT

Provider Business Mailing Address
First Line	:	3501 5TH AVE STE C2
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-2155
Country	:	US
Telephone Number	:	337-439-3344
Fax Number	:	337-439-3380

Provider Business Practice Location Address
First Line	:	3501 5TH AVE STE C2
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70607-2155
Country	:	US
Telephone Number	:	337-439-3344
Fax Number	:	337-439-3380

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

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	05/27/2026

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