Provider Demographics
NPI:1093906612
Name:MISODA, MICHAEL BRIAN (PT,GCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:MISODA
Suffix:
Gender:M
Credentials:PT,GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 WOODCREST LN
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-2948
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ABINGTON MEMORIAL HOSPITAL
Practice Address - Street 2:1200 OLD YORK ROAD
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3788
Practice Address - Country:US
Practice Address - Phone:215-481-2921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009028L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist