Provider Demographics
NPI:1912949520
Name:PAGE, MICHELLE MOSESSON (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MOSESSON
Last Name:PAGE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:MOSESSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6 GLENVIEW PL
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3702
Mailing Address - Country:US
Mailing Address - Phone:856-220-0117
Mailing Address - Fax:
Practice Address - Street 1:175 OXFORD RD
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-2313
Practice Address - Country:US
Practice Address - Phone:856-220-0117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01137000225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200124039Medicare UPIN