Provider Demographics
NPI:1700314648
Name:MICHELETTI, CARLO ALBERTO PRECISO
Entity type:Individual
Prefix:MR
First Name:CARLO
Middle Name:ALBERTO PRECISO
Last Name:MICHELETTI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 NW 18TH PL
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5695
Mailing Address - Country:US
Mailing Address - Phone:954-496-0185
Mailing Address - Fax:
Practice Address - Street 1:8612 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328-3719
Practice Address - Country:US
Practice Address - Phone:954-252-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTAT27610225200000X
FLPTA27610225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant