Provider Demographics
NPI:1104788959
Name:TRESSA, MICHAEL JACOB (PTA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JACOB
Last Name:TRESSA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 N PINE ST # A
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-2141
Mailing Address - Country:US
Mailing Address - Phone:267-789-2900
Mailing Address - Fax:
Practice Address - Street 1:182 N PINE ST # A
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-2141
Practice Address - Country:US
Practice Address - Phone:267-789-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-01
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE013899225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty