Provider Demographics
NPI:1528080058
Name:CLEARY, MICHELLE A (PHD, ATC, LAT)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:A
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PHD, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FLORIDA INTERNATIONAL UNIVERSITY
Mailing Address - Street 2:11200 SW 8TH ST ZEB 251A UP, DEPT OF HPER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33199-0001
Mailing Address - Country:US
Mailing Address - Phone:305-348-6335
Mailing Address - Fax:
Practice Address - Street 1:FLORIDA INTERNATIONAL UNIVERSITY
Practice Address - Street 2:11200 SW 8TH ST ZEB 251A UP, DEPT OF HPER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33199-0001
Practice Address - Country:US
Practice Address - Phone:305-348-6335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 16502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer