Provider Demographics
NPI:1386312718
Name:TOBUREN, MICHELLE DAWN (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAWN
Last Name:TOBUREN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 CLOVER LN
Mailing Address - Street 2:
Mailing Address - City:PERKIOMENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18074-9485
Mailing Address - Country:US
Mailing Address - Phone:267-664-1488
Mailing Address - Fax:
Practice Address - Street 1:2849 BIG RD
Practice Address - Street 2:
Practice Address - City:ZIEGLERVILLE
Practice Address - State:PA
Practice Address - Zip Code:19492-1302
Practice Address - Country:US
Practice Address - Phone:610-754-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012872L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist