Provider Demographics
NPI:1922179142
Name:MICKLE, TRISHA DAWN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:DAWN
Last Name:MICKLE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:TRISHA
Other - Middle Name:DAWN
Other - Last Name:BARNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3661 BRUMBAUGH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ENTERPRISE
Mailing Address - State:PA
Mailing Address - Zip Code:16664-8822
Mailing Address - Country:US
Mailing Address - Phone:814-766-2451
Mailing Address - Fax:
Practice Address - Street 1:428 S MARKET ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:PA
Practice Address - Zip Code:16662-1014
Practice Address - Country:US
Practice Address - Phone:814-793-3428
Practice Address - Fax:814-793-3491
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001349L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant