Provider Demographics
NPI:1366845604
Name:PIERRY, MICHELE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:PIERRY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 JAMESTOWN CT
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-4376
Mailing Address - Country:US
Mailing Address - Phone:215-393-1519
Mailing Address - Fax:
Practice Address - Street 1:1390 CAMP HILL RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2805
Practice Address - Country:US
Practice Address - Phone:215-643-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA018599225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007783630018Medicaid