Provider Demographics
NPI:1447329206
Name:VALENCIA, MICHELLE L (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:VALENCIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:L
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4951 LONG PRAIRIE RD
Mailing Address - Street 2:STE. 110
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2707
Mailing Address - Country:US
Mailing Address - Phone:972-410-5777
Mailing Address - Fax:972-410-5778
Practice Address - Street 1:4951 LONG PRAIRIE RD
Practice Address - Street 2:STE. 110
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2707
Practice Address - Country:US
Practice Address - Phone:972-410-5777
Practice Address - Fax:972-410-5778
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6840OtherBCBS TX
TX8G3671Medicare PIN