Provider Demographics
NPI:1114213808
Name:KESTER, MICHELLE L (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:KESTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MEDIATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:625 LINCOLN AVE
Mailing Address - Street 2:STE 107 PROFESSIONAL PLAZA
Mailing Address - City:CHARLEROI
Mailing Address - State:PA
Mailing Address - Zip Code:15022-2451
Mailing Address - Country:US
Mailing Address - Phone:724-483-1673
Mailing Address - Fax:724-483-0290
Practice Address - Street 1:1985 LINCOLN WAY
Practice Address - Street 2:RAINBOW VILLAGE SHOPPING CENTER
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2418
Practice Address - Country:US
Practice Address - Phone:412-672-2352
Practice Address - Fax:412-672-2657
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist