Healthcare Provider Details

I. General information

NPI: 1144291105
Provider Name (Legal Business Name): MICHELLE LOUISE BIEBER PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MICHELLE LOUISE KOSLOSKY PT

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 BROAD ST
MONTOURSVILLE PA
17754
US

IV. Provider business mailing address

1009 BROAD ST
MONTOURSVILLE PA
17754
US

V. Phone/Fax

Practice location:
  • Phone: 570-368-8389
  • Fax: 570-368-8391
Mailing address:
  • Phone: 570-368-8389
  • Fax: 570-368-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT010890L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: