Michaela Davenport
Individual provider Active NPI Physical Therapist · Agawam, MA
NPI 1750193512 · NPPES record last updated Jan 20, 2025
Key facts
- NPI
- 1750193512
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- Practice address
- 470 Shoemaker LN
Agawam, MA 01001-3620 - Phone
- (413) 789-0752
- NPI assigned
- Jan 20, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250206001879 | MA | Practitioner - Physical Therapist in Private Practice | 5597295550 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resilience Physical Therapy and Wellness, LLC | Physical Therapist | Current |
Accepting new patients |
Locations
470 Shoemaker Ln
Agawam, MA 01001
Phone (413) 789-0752
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Yes |
Addresses
Primary practice location
470 Shoemaker LN
Agawam, MA 01001-3620
Mailing address
1 Meg PL
Rochdale, MA 01542-1030
Other providers in Agawam, MA
- Suzanne Louise Cunningham
- CVS Pharmacy Inc
- CVS Pharmacy Inc
- Cynthia L Lydiard
- Julie J D'Avanzo
- Deborah Hunter, LMHC
- Denise Miller-Zhang, PC
- Dental Studio Associates, LLC
- Garima Devi
- Kimberly A. Dewey
All providers in Agawam, MA · Physical Therapist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 20, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.