Provider Demographics
NPI:1215484134
Name:WILLIGAN, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:WILLIGAN
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 1:10 TREE TOP RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3713
Mailing Address - Country:US
Mailing Address - Phone:484-459-0795
Mailing Address - Fax:
Practice Address - Street 1:201 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2141
Practice Address - Country:US
Practice Address - Phone:908-788-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01446300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist