Provider Demographics
NPI:1518038280
Name:EMERSON, MICHELLE JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEAN
Last Name:EMERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:MICHELLE
Other - Middle Name:JEAN
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3222 BENSHOFF HILL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-3606
Mailing Address - Country:US
Mailing Address - Phone:814-322-4943
Mailing Address - Fax:
Practice Address - Street 1:429 S MARKET ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1005
Practice Address - Country:US
Practice Address - Phone:814-793-5206
Practice Address - Fax:814-793-3818
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE002764L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant