Healthcare Provider Details

I. General information

NPI: 1053700674
Provider Name (Legal Business Name): MICHELLE LYNN ADAMS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

IV. Provider business mailing address

701 ROUSE AVE
YOUNGSVILLE PA
16371-1605
US

V. Phone/Fax

Practice location:
  • Phone: 814-563-6478
  • Fax: 814-563-6697
Mailing address:
  • Phone: 814-563-6478
  • Fax: 814-563-6697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023843
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: