Provider Demographics
NPI:1417416793
Name:BIONDO, MICHELLE CHRISTINE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:BIONDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:ESWORTHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 LARSON COURT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157
Mailing Address - Country:US
Mailing Address - Phone:410-917-1871
Mailing Address - Fax:
Practice Address - Street 1:520 LARSON COURT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157
Practice Address - Country:US
Practice Address - Phone:410-917-1871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2022-05-04
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2022-05-04
Provider Licenses
StateLicense IDTaxonomies
MDA4062225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA4062Medicaid