Provider Demographics
NPI:1104088616
Name:ARMEDILLA, MICHELLE MORESCA (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MORESCA
Last Name:ARMEDILLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 LINDEN PL
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-3042
Mailing Address - Country:US
Mailing Address - Phone:818-648-3043
Mailing Address - Fax:718-518-1244
Practice Address - Street 1:229 LINDEN PLACE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646
Practice Address - Country:US
Practice Address - Phone:818-648-3043
Practice Address - Fax:718-518-1244
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0292591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist