Individual
MICHELLE M THEIS-BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2730 WILSHIRE BLVD STE 533, SANTA MONICA, CA 90403-4751
(310) 828-0101
Mailing address
9129 NATIONAL BLVD APT 5, LOS ANGELES, CA 90034-8534
(614) 354-6268
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
49327
CA
Other
Enumeration date
05/22/2018
Last updated
05/22/2018
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