Healthcare Provider Details

I. General information

NPI: 1720994668
Provider Name (Legal Business Name): MICHELLE MARIE MARCHO PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 WOODLANDS DR
WAYMART PA
18472-9366
US

IV. Provider business mailing address

1445 STATE ROUTE 106 APT C
CLIFFORD TOWNSHIP PA
18407-7820
US

V. Phone/Fax

Practice location:
  • Phone: 570-488-7130
  • Fax:
Mailing address:
  • Phone: 570-960-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberTE1001160
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: