Individual
MICHELLE LONDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1701 MADISON ST, 2F, RIDGEWOOD, NY 11385-3698
(386) 801-3063
Mailing address
1701 MADISON ST, 2F, RIDGEWOOD, NY 11385-3698
(386) 801-3063
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007823
NY
Other
Enumeration date
12/07/2011
Last updated
12/07/2011
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