Provider Demographics
NPI:1053700674
Name:ADAMS, MICHELLE LYNN (PT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:LYNN
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ROUSE AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16371-1605
Mailing Address - Country:US
Mailing Address - Phone:814-563-6478
Mailing Address - Fax:814-563-6697
Practice Address - Street 1:701 ROUSE AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16371-1605
Practice Address - Country:US
Practice Address - Phone:814-563-6478
Practice Address - Fax:814-563-6697
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023843225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist