Individual
MRS. MICHELLE VANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1525 HERBERT ST, PORT ORANGE, FL 32129-6106
(386) 756-0424
Mailing address
365 BENT OAK DR, PORT ORANGE, FL 32127-5979
(386) 299-9078
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTAT25762
FL
Other
Enumeration date
07/10/2015
Last updated
07/10/2015
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