Provider Demographics
NPI:1043579865
Name:THORPE, MICHELLE BURGESS (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:BURGESS
Last Name:THORPE
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 1:1063 MOSSER RD
Mailing Address - Street 2:APT C203
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1353
Mailing Address - Country:US
Mailing Address - Phone:321-505-2123
Mailing Address - Fax:
Practice Address - Street 1:1718 SPRING CREEK RD
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9784
Practice Address - Country:US
Practice Address - Phone:610-366-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE009298225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant