Provider Demographics
NPI:1093003881
Name:DENISON, MICHELLE DYER
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DYER
Last Name:DENISON
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 1:8679 ELMER HILL RD
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-9314
Mailing Address - Country:US
Mailing Address - Phone:315-339-4836
Mailing Address - Fax:315-339-1742
Practice Address - Street 1:8679 ELMER HILL RD
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-9314
Practice Address - Country:US
Practice Address - Phone:315-339-4836
Practice Address - Fax:315-339-1742
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016607-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist