1417514498 NPI number — MICHELLE DANIELLE HRISEU CCTA

Table of content: MICHELLE DANIELLE HRISEU CCTA (NPI 1417514498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417514498 NPI number — MICHELLE DANIELLE HRISEU CCTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HRISEU
Provider First Name:
MICHELLE
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CCTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONTEA
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417514498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
THE CENTER FOR PEDIATRIC THERAPY INC
Provider Second Line Business Mailing Address:
9 BRISTOL CT
Provider Business Mailing Address City Name:
WYOMISSING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-670-8600
Provider Business Mailing Address Fax Number:
610-670-9104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
THE CENTER FOR PEDIATRIC THERAPY INC
Provider Second Line Business Practice Location Address:
9 BRISTOL CT
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-670-8600
Provider Business Practice Location Address Fax Number:
610-670-9104
Provider Enumeration Date:
05/24/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 224Z00000X , with the licence number:  OP009331 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)