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General NPI Number Information
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NPI Number | 1275492605
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Entity Type | Individual
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Provider Name | MICHELE LOUISE BIANCULLI-KOLP
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Gender | Female
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Dates
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Enumeration Date | 01/21/2026
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 658 PA-739
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City | LORDS VALLEY
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State | PA
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Zip | 18444-6054
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Country | US
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Telephone | 570-775-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 233 CEMETERY RD
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City | MOSCOW
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State | PA
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Zip | 18444-6054
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Country | US
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Telephone | 570-906-1156
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TE1004174
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License Number State | PA
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