Healthcare Provider Details

I. General information

NPI: 1992821003
Provider Name (Legal Business Name): MICHELLE DEE MCCALLISTER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 NEW RD
CHURCHVILLE PA
18966-1444
US

IV. Provider business mailing address

79 NEW RD
CHURCHVILLE PA
18966-1444
US

V. Phone/Fax

Practice location:
  • Phone: 267-240-1680
  • Fax:
Mailing address:
  • Phone: 267-240-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34477
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT009311L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: