Provider Demographics
NPI:1851519946
Name:DWERTMAN, MICHELLE NICOLE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:DWERTMAN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4245 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-2162
Mailing Address - Country:US
Mailing Address - Phone:513-320-6338
Mailing Address - Fax:
Practice Address - Street 1:200 ALBERT SABIN WAY STE 1200
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-2800
Practice Address - Country:US
Practice Address - Phone:513-475-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist