Healthcare Provider Details

I. General information

NPI: 1760463905
Provider Name (Legal Business Name): MICHELLE C WITHROW PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE C BRINSKO PT

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL STE 1100
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 234-287-6660
  • Fax: 234-287-6669
Mailing address:
  • Phone: 330-729-8146
  • Fax: 330-965-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: