Healthcare Provider Details

I. General information

NPI: 1760823298
Provider Name (Legal Business Name): MICHELLE LAMB PT, AT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELLEY LAMB PT, AT

II. Dates (important events)

Enumeration Date: 07/12/2013
Last Update Date: 07/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13101 AIR HILL RD
BROOKVILLE OH
45309-9761
US

IV. Provider business mailing address

13101 AIR HILL RD
BROOKVILLE OH
45309-9761
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-9350
  • Fax:
Mailing address:
  • Phone: 937-833-9350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 009747
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT 001770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: