Provider Demographics
NPI:1164141073
Name:RAPAPORT, MICHELE SELINA (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SELINA
Last Name:RAPAPORT
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 1:378 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7451
Mailing Address - Country:US
Mailing Address - Phone:407-234-0164
Mailing Address - Fax:
Practice Address - Street 1:378 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7451
Practice Address - Country:US
Practice Address - Phone:407-234-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA89966-AH-PA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant