Provider Demographics
NPI:1689479693
Name:CASE, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-0461
Mailing Address - Country:US
Mailing Address - Phone:515-382-3366
Mailing Address - Fax:515-382-1576
Practice Address - Street 1:PO BOX 461
Practice Address - Street 2:
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-0461
Practice Address - Country:US
Practice Address - Phone:515-382-3366
Practice Address - Fax:515-382-1576
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1114963154Medicaid
IA1114963154OtherMEDICARE
IA1174783583OtherMEDICARE
IA1174783583OtherCOMMERCIAL
IA1407016819OtherCOMMERCIAL
IA1174783583Medicaid
IA1407016819OtherMEDICARE
IA1982353140OtherMEDICARE
IA1982353140Medicaid
IA1114963154OtherCOMMERCIA
IA1407016819Medicaid