Provider Demographics
NPI:1356659858
Name:PEARSALL, MICHELLE MARIE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:MARIE
Last Name:PEARSALL
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 1:284 PORTER RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-3903
Mailing Address - Country:US
Mailing Address - Phone:518-483-6691
Mailing Address - Fax:
Practice Address - Street 1:183 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-2226
Practice Address - Country:US
Practice Address - Phone:518-483-7802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005498225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant