MEDICARE: MRS. MICHELLE NICOLE DWERTMAN MSPT

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	013640	OH

General Provider Information

NPI Number	:	1851519946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE NICOLE DWERTMAN MSPT

Provider Business Mailing Address
First Line	:	4245 BROOKSIDE AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-2162
Country	:	US
Telephone Number	:	513-320-6338
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 ALBERT SABIN WAY STE 1200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45267-2800
Country	:	US
Telephone Number	:	513-475-8881
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	08/21/2024

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