MEDICARE: MISS MICHAELA ANN NORTHRUP PT

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	225100000X	Physical Therapist	022776	NY

General Provider Information

NPI Number	:	1700807278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHAELA ANN NORTHRUP PT

Provider Business Mailing Address
First Line	:	22 WINSTON WOODS
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-2017
Country	:	US
Telephone Number	:	585-395-9176
Fax Number	:

Provider Business Practice Location Address
First Line	:	16 MAIN ST
Second Line	:
City	:	HILTON
State	:	NY
Zip	:	14468-1211
Country	:	US
Telephone Number	:	585-392-8100
Fax Number	:

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/09/2007

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