Provider Demographics
NPI:1730572231
Name:SHRAWDER, MICHALEEN PATRICIA (PTA)
Entity type:Individual
Prefix:MRS
First Name:MICHALEEN
Middle Name:PATRICIA
Last Name:SHRAWDER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 PEABODY ROAD
Mailing Address - Street 2:APT 243
Mailing Address - City:VACACILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:724-877-2582
Mailing Address - Fax:
Practice Address - Street 1:624 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:PA
Practice Address - Zip Code:15202-2606
Practice Address - Country:US
Practice Address - Phone:724-877-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT10705225200000X
PATE1003054225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant