Provider Demographics
NPI:1548531601
Name:DART, MICHELE LEE
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:DART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LEE
Other - Last Name:CONKRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4554 W 48TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-8721
Mailing Address - Country:US
Mailing Address - Phone:231-924-9295
Mailing Address - Fax:231-924-9371
Practice Address - Street 1:4554 W 48TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-8721
Practice Address - Country:US
Practice Address - Phone:231-924-9295
Practice Address - Fax:231-924-9371
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2045419225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant