Provider Demographics
NPI:1710008164
Name:HAIN, MICHELE JO (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:JO
Last Name:HAIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6981 N PARK DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PENNSAUKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:856-910-1200
Mailing Address - Fax:856-910-7800
Practice Address - Street 1:6981 N PARK DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PENNSAUKIN
Practice Address - State:NJ
Practice Address - Zip Code:08109
Practice Address - Country:US
Practice Address - Phone:856-910-1200
Practice Address - Fax:856-910-7800
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA000890100225100000X
PAPT012899L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA000890100OtherNEW JERSEY LICENSE
PAPT012899LOtherPENNSYLVANIA LICENSE