Provider Demographics
NPI:1568625010
Name:MORRISSEY, MICHELLE DANIELLE (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DANIELLE
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E BROAD ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-1263
Mailing Address - Country:US
Mailing Address - Phone:215-723-9688
Mailing Address - Fax:215-723-3310
Practice Address - Street 1:601 E BROAD ST
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964-1263
Practice Address - Country:US
Practice Address - Phone:215-723-9688
Practice Address - Fax:215-723-3310
Is Sole Proprietor?:No
Enumeration Date:2008-07-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005935213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE254891ZF5OtherMEDICARE/PTAN