Provider Demographics
NPI:1639133796
Name:AGOSTINELLI, MICHELE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:AGOSTINELLI
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 1:1300 OXFORD DR STE 1F
Mailing Address - Street 2:
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1800
Mailing Address - Country:US
Mailing Address - Phone:412-851-8850
Mailing Address - Fax:412-851-8855
Practice Address - Street 1:1300 OXFORD DR STE 1F
Practice Address - Street 2:
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1800
Practice Address - Country:US
Practice Address - Phone:412-851-8850
Practice Address - Fax:412-851-8855
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011993L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist