Provider Demographics
NPI:1285614925
Name:HARKNESS, MICHELLE DIANE (PT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DIANE
Last Name:HARKNESS
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 1:535 OFFICENTER PL
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:42230
Mailing Address - Country:US
Mailing Address - Phone:614-471-0036
Mailing Address - Fax:614-471-0087
Practice Address - Street 1:535 OFFICENTER PL
Practice Address - Street 2:SUITE C
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230
Practice Address - Country:US
Practice Address - Phone:614-471-0036
Practice Address - Fax:614-471-0087
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT07185225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000013775OtherANTHEM
OH2055421Medicaid