Provider Demographics
NPI:1316110992
Name:WITHEROW, MICHELLE M
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:M
Last Name:WITHEROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 MYERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GARDNERS
Mailing Address - State:PA
Mailing Address - Zip Code:17324-9037
Mailing Address - Country:US
Mailing Address - Phone:717-323-0321
Mailing Address - Fax:717-323-0322
Practice Address - Street 1:1065 MYERSTOWN RD
Practice Address - Street 2:
Practice Address - City:GARDNERS
Practice Address - State:PA
Practice Address - Zip Code:17324-9037
Practice Address - Country:US
Practice Address - Phone:717-323-0321
Practice Address - Fax:717-323-0322
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA92797683251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health