Provider Demographics
NPI:1174775001
Name:PIRES, MICHELLE ELIZABETH (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:PIRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRADLEY BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07720-1062
Mailing Address - Country:US
Mailing Address - Phone:732-807-4720
Mailing Address - Fax:732-807-7037
Practice Address - Street 1:2 MAIN STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1060
Practice Address - Country:US
Practice Address - Phone:732-807-4720
Practice Address - Fax:732-807-7037
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist