Provider Demographics
NPI:1386800332
Name:JADLOCKI, MICHELLE LEE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:JADLOCKI
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 1:136 WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-1433
Mailing Address - Country:US
Mailing Address - Phone:814-360-3120
Mailing Address - Fax:
Practice Address - Street 1:929 14TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-3028
Practice Address - Country:US
Practice Address - Phone:814-643-0337
Practice Address - Fax:814-643-9231
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist