MEDICARE: MICHELLE DAVID PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	A3146	MD

General Provider Information

NPI Number	:	1710250428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE DAVID PTA

Provider Business Mailing Address
First Line	:	7748 MAYFAIR CIR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6970
Country	:	US
Telephone Number	:	301-922-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	7748 MAYFAIR CIR
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6970
Country	:	US
Telephone Number	:	301-922-7031
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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Directions to “ MICHELLE DAVID PTA” Practice Location

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