Healthcare Provider Details

I. General information

NPI: 1104088616
Provider Name (Legal Business Name): MICHELLE MORESCA ARMEDILLA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 LINDEN PLACE
NEW MILFORD NJ
07646
US

IV. Provider business mailing address

229 LINDEN PL
NEW MILFORD NJ
07646-3042
US

V. Phone/Fax

Practice location:
  • Phone: 818-648-3043
  • Fax: 718-518-1244
Mailing address:
  • Phone: 818-648-3043
  • Fax: 718-518-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0292591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: