Provider Demographics
NPI:1689006744
Name:STARACE, MICHAEL BRANDON (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRANDON
Last Name:STARACE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 BANNBURY LN
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-8848
Mailing Address - Country:US
Mailing Address - Phone:732-668-4988
Mailing Address - Fax:
Practice Address - Street 1:2550 N STATE ST UNIT 4
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-3418
Practice Address - Country:US
Practice Address - Phone:386-385-8749
Practice Address - Fax:386-693-1798
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist