Provider Demographics
NPI:1558637389
Name:MANCHESTER, MICHELE LYNN (PT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNN
Last Name:MANCHESTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:MANCHESTER-CONRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:55 MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3311
Mailing Address - Country:US
Mailing Address - Phone:718-761-3325
Mailing Address - Fax:
Practice Address - Street 1:55 MERRILL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3311
Practice Address - Country:US
Practice Address - Phone:718-761-3325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY87862251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics