Active NPI
Michelle Theresa Medina, PTA
- Physical Therapy Assistant
- Nazareth, PA
National Provider Identifier
1205959780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- TE001495
- Practice address
- Gracedale Ave
Nazareth, PA 18064 - Phone
- (610) 746-1909
- NPI assigned
- Apr 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | TE001495 | PA | Primary |
Addresses
Primary practice location
Gracedale Ave
Nazareth, PA 18064
Mailing address
2413 Forest St FRNT
Easton, PA 18042-5367
Phone (610) 751-7558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TE001495 | PA | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205959780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2413 FOREST ST FRNT",
"city": "EASTON",
"state": "PA",
"postal_code": "180425367",
"telephone_number": "610-751-7558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "GRACEDALE AVE",
"city": "NAZARETH",
"state": "PA",
"postal_code": "18064",
"telephone_number": "610-746-1909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDINA",
"first_name": "MICHELLE",
"middle_name": "THERESA",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "PA",
"license": "TE001495",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Nazareth, PA
- Jouzaphin Manja, PHARMACIST
- Marci Pambianchi LLC
- James J Martin, MD
- James Mauro Jr., PHARMD
- Tyler Daniel McCrone, DPT
- Alexis Kristine Meixsell
- Jason James Meixsell, OTR/L
- Mental Health and Sport Performance Counseling of the Lehigh Valley
- Mental Health Counseling of Nazareth
- Merchant Chiropractic LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.