1255696829 NPI number — MICHELLE ANTOINETTE KILHEFFER DPT

Table of content: MICHELLE ANTOINETTE KILHEFFER DPT (NPI 1255696829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255696829 NPI number — MICHELLE ANTOINETTE KILHEFFER DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KILHEFFER
Provider First Name:
MICHELLE
Provider Middle Name:
ANTOINETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOETTERITZ
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
ANTOINETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255696829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 DERRY ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
HARRISBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17111-3576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-839-2110
Provider Business Mailing Address Fax Number:
717-565-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 NOLL DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17603-7606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-391-9920
Provider Business Practice Location Address Fax Number:
717-391-9925
Provider Enumeration Date:
07/10/2012

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: 225100000X , with the licence number:  PT022022 , 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)





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