Provider Demographics
NPI:1639689847
Name:DENNIS, MICHELLE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:DENNIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5530 WESTFALL RD SW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-9261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3680 DOLSON CT
Practice Address - Street 2:
Practice Address - City:CARROLL
Practice Address - State:OH
Practice Address - Zip Code:43112-9721
Practice Address - Country:US
Practice Address - Phone:740-654-0641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant