MEDICARE: MICHELLE LYNNE CHRISTMAS PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA001402	WV

General Provider Information

NPI Number	:	1457677411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE LYNNE CHRISTMAS PTA

Provider Business Mailing Address
First Line	:	219 CHARLESTON AVE
Second Line	:
City	:	CLARKSBURG
State	:	WV
Zip	:	26301-2211
Country	:	US
Telephone Number	:	304-476-8705
Fax Number	:	304-622-4747

Provider Business Practice Location Address
First Line	:	435 BUCKHANNON PIKE
Second Line	:
City	:	NUTTER FORT
State	:	WV
Zip	:	26301-4307
Country	:	US
Telephone Number	:	304-622-1600
Fax Number	:	304-622-4747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	04/15/2010

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