Provider Demographics
NPI:1457668253
Name:CASTLE, MICHELLE MARIE (LPTA)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:MARIE
Last Name:CASTLE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 STATE HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:13733-3138
Mailing Address - Country:US
Mailing Address - Phone:607-639-2852
Mailing Address - Fax:
Practice Address - Street 1:2223 STATE HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:13733-3138
Practice Address - Country:US
Practice Address - Phone:607-639-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006139-1OtherNEW YORK STATE LICENSE