Healthcare Provider Details

I. General information

NPI: 1174052963
Provider Name (Legal Business Name): MICHAELA HESS PTA, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 STATE ROUTE 17M
MONROE NY
10950-4123
US

IV. Provider business mailing address

143 VALLEY VIEW AVE
MONROE NY
10950-1156
US

V. Phone/Fax

Practice location:
  • Phone: 845-507-0477
  • Fax: 845-507-0490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number001935-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number007487-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: