Provider Demographics
NPI:1871761734
Name:INFANZON, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:INFANZON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 CALLE CACIMAR
Mailing Address - Street 2:LOS CACIQUES
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-8711
Mailing Address - Country:US
Mailing Address - Phone:787-413-6310
Mailing Address - Fax:787-752-0348
Practice Address - Street 1:184 CALLE CACIMAR
Practice Address - Street 2:LOS CACIQUES
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8711
Practice Address - Country:US
Practice Address - Phone:787-413-6310
Practice Address - Fax:787-752-0348
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist