Basic Information
| Provider Information | |||||||||
| NPI: | 1134386816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEMIDEY | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4543 CHARLOTTE HWY STE 11 | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297107057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038311454 | ||||||||
| FaxNumber: | 8038311455 | ||||||||
| Practice Location | |||||||||
| Address1: | 4543 CHARLOTTE HWY STE 11 | ||||||||
| Address2: | |||||||||
| City: | LAKE WYLIE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297107057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8038311454 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2008 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 19894 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.