Provider Demographics
NPI:1396885885
Name:SMITH, MICHELLE ELAINE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:SMITH
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 1:1855 POWDER MILL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-4723
Mailing Address - Country:US
Mailing Address - Phone:717-848-4800
Mailing Address - Fax:717-741-4759
Practice Address - Street 1:1855 POWDER MILL RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-4723
Practice Address - Country:US
Practice Address - Phone:717-848-4800
Practice Address - Fax:717-741-4759
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012202L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA177124OtherMEDICARE HGS ADMINISTRATO
PA18444OtherHEALTH AMERICA
PA0068377000OtherAMERIHEALTH UNDER IBC
PA03182100OtherCAPITAL BLUE CROSS
PACK4276OtherPALMETTO GBA RR MEDICARE
PA332313OtherHIGHMARK BLUE SHIELD
PA0197900001Medicare NSC