Healthcare Provider Details

I. General information

NPI: 1922179142
Provider Name (Legal Business Name): TRISHA DAWN MICKLE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS TRISHA DAWN BARNETT

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 S MARKET ST
MARTINSBURG PA
16662-1014
US

IV. Provider business mailing address

3661 BRUMBAUGH RD
NEW ENTERPRISE PA
16664-8822
US

V. Phone/Fax

Practice location:
  • Phone: 814-793-3428
  • Fax: 814-793-3491
Mailing address:
  • Phone: 814-766-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE001349L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: