Provider Demographics
NPI:1598922189
Name:TOLPA, MICHELE LYNN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNN
Last Name:TOLPA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10927 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4383
Mailing Address - Country:US
Mailing Address - Phone:315-725-3849
Mailing Address - Fax:
Practice Address - Street 1:10927 THORNWOOD DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-4383
Practice Address - Country:US
Practice Address - Phone:315-725-3849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030278-1225100000X
TX122633225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist