Basic Information
Provider Information
NPI: 1386643153
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRICE
FirstName: MICHAEL
MiddleName: KENNETH
NamePrefix:  
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Practice Location
Address1: 2775 SCHOENERSVILLE RD
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180177307
CountryCode: US
TelephoneNumber: 6108618080
FaxNumber: 6108070366
Other Information
ProviderEnumerationDate: 07/14/2005
LastUpdateDate: 01/30/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XPT015119PAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

ID Information
IDTypeStateIssuerDescription
217051501 MAMSIOTHER
82169301 FIRST PRIORITY HEALTHOTHER
220126501 UNITED HEALTHCAREOTHER
724608901 CIGNA HEALTHCAREOTHER
P317605601 OXFORD HEALTH PLANSOTHER
131443701 HIGHMARK BLUE SHIELDOTHER
200827100001 AMERIHEALTHOTHER
P0001064001 MEDICARE RAILROADOTHER
32901401 HEALTHAMERICA/HEALTHASSUROTHER
4724101 GEISINGER HEALTH PLANOTHER
200827100001 KEYSTONE HEALTH EASTOTHER
02266020101 CAPITAL BLUE CROSSOTHER
262708301 AETNA PPOOTHER
02266020101 KEYSTONE HEALTH CENTRALOTHER
200827100001 INDEPENDENCE BLUE CROSSOTHER


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