Provider Demographics
NPI:1922124213
Name:GOTTHARDT WEINKAUF, MICHELLE LINN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LINN
Last Name:GOTTHARDT WEINKAUF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:LINN
Other - Last Name:GOTTHARDT WEINKAUF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSPT
Mailing Address - Street 1:277 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-4245
Mailing Address - Country:US
Mailing Address - Phone:516-593-6749
Mailing Address - Fax:
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:212-982-5268
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13478-1OtherPT LICENSE