Provider Demographics
NPI:1740762251
Name:DANGERFIELD, MICHELE (PTA)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DANGERFIELD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 GOVERNORS DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19086-6623
Mailing Address - Country:US
Mailing Address - Phone:610-872-0591
Mailing Address - Fax:
Practice Address - Street 1:1048 W BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-6300
Practice Address - Country:US
Practice Address - Phone:610-891-3861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE010780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant