Provider Demographics
NPI:1417158585
Name:PESHICK, MICHELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:PESHICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 DETTMAR TER
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1220
Mailing Address - Country:US
Mailing Address - Phone:856-933-5169
Mailing Address - Fax:
Practice Address - Street 1:1930 MARLTON PIKE E
Practice Address - Street 2:SUITE A7
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2150
Practice Address - Country:US
Practice Address - Phone:856-424-0993
Practice Address - Fax:856-424-0994
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA012003002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic