Basic Information
| Provider Information | |||||||||
| NPI: | 1518235654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIRBEL | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2448 S 102ND ST | ||||||||
| Address2: | STE. 340 | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532272466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008777018 | ||||||||
| FaxNumber: | 4143292505 | ||||||||
| Practice Location | |||||||||
| Address1: | N7135 ROCKY KNOLL PKWY | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530733103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204491254 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2011 | ||||||||
| LastUpdateDate: | 12/04/2011 | ||||||||
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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 | 225200000X | 1738019 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1738019 | 01 | WI | PTA LICENSURE | OTHER |