Provider Demographics
NPI:1902968985
Name:PRICE, MICHAEL TED (RPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:TED
Last Name:PRICE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 WINDSONG LOOP
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36093-3081
Mailing Address - Country:US
Mailing Address - Phone:334-514-8807
Mailing Address - Fax:
Practice Address - Street 1:743 WINDSONG LOOP
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36093-3081
Practice Address - Country:US
Practice Address - Phone:334-514-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist