Provider Demographics
NPI:1346721636
Name:WOTRING, MICHELE L (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:WOTRING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:L
Other - Last Name:GROVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:150 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1141
Mailing Address - Country:US
Mailing Address - Phone:304-329-1400
Mailing Address - Fax:304-329-1175
Practice Address - Street 1:37 MORGANTOWN STREET
Practice Address - Street 2:
Practice Address - City:BRUCETON MILLS
Practice Address - State:WV
Practice Address - Zip Code:26525
Practice Address - Country:US
Practice Address - Phone:304-379-7678
Practice Address - Fax:304-379-4937
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPT004012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist