Basic Information
| Provider Information | |||||||||
| NPI: | 1861728511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CLORINA | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | LACSON | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352155858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055209600 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | CENTER POINT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352155858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055209600 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2009 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070017423 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 030823 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 008650 | CT | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.