MEDICARE: MICHELLE LYNN UNTERBERG PT

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	225100000X	Physical Therapist	R1231	MO

General Provider Information

NPI Number	:	1851419998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNN UNTERBERG PT

Provider Business Mailing Address
First Line	:	9132 LAWN AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63144-1607
Country	:	US
Telephone Number	:	314-961-8581
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 SOUTH WOODS MILL ROAD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-1607
Country	:	US
Telephone Number	:	314-542-4767
Fax Number	:

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

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	07/08/2007

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