Provider Demographics
NPI:1851519946
Name:DWERTMAN, MICHELLE NICOLE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:DWERTMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LINCOLN RD
Mailing Address - Street 2:3L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4109
Mailing Address - Country:US
Mailing Address - Phone:513-320-6338
Mailing Address - Fax:
Practice Address - Street 1:169 ADELPHI ST
Practice Address - Street 2:2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3301
Practice Address - Country:US
Practice Address - Phone:513-320-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist