Provider Demographics
NPI:1366970410
Name:ADAME, MICHELE (PT)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:ADAME
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 1:6264 NAPOLI CT
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-4864
Mailing Address - Country:US
Mailing Address - Phone:562-544-9566
Mailing Address - Fax:
Practice Address - Street 1:7860 IMPERIAL HWY STE E
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3464
Practice Address - Country:US
Practice Address - Phone:562-923-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21905225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA3792013OtherDRIVERS LICENSE