Provider Demographics
NPI:1578717518
Name:STAKE, MICHELE A (MHS, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:A
Last Name:STAKE
Suffix:
Gender:F
Credentials:MHS, DPT
Other - Prefix:DR
Other - First Name:MICHELE
Other - Middle Name:A
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, DPT
Mailing Address - Street 1:450 LEVERING MILL RD
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1239
Mailing Address - Country:US
Mailing Address - Phone:610-667-5973
Mailing Address - Fax:
Practice Address - Street 1:450 LEVERING MILL RD
Practice Address - Street 2:
Practice Address - City:MERION STATION
Practice Address - State:PA
Practice Address - Zip Code:19066-1239
Practice Address - Country:US
Practice Address - Phone:610-667-5973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT000478E2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic