Basic Information
Provider Information
NPI: 1790945293
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BATTINELLI
FirstName: MICHELE
MiddleName: GUILLEN
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 350 NEW FIDELITY CT
Address2:  
City: GARNER
State: NC
PostalCode: 275292665
CountryCode: US
TelephoneNumber: 9192582714
FaxNumber: 4106484878
Practice Location
Address1: 2328 W JOPPA RD
Address2: SUITE 300
City: LUTHERVILLE
State: MD
PostalCode: 210934612
CountryCode: US
TelephoneNumber: 4109388660
FaxNumber: 4109388664
Other Information
ProviderEnumerationDate: 06/10/2008
LastUpdateDate: 11/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X16069MDY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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