Basic Information
| Provider Information | |||||||||
| NPI: | 1124096466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MICHELS | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | SAM | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4401 LONG PRAIRIE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750281794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726911331 | ||||||||
| FaxNumber: | 9726911731 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 LONG PRAIRIE RD | ||||||||
| Address2: | STE 300 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750281794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726911331 | ||||||||
| FaxNumber: | 9726911731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2006 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1116259 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 83594T | 01 | TX | BCBS | OTHER |