Basic Information
| Provider Information | |||||||||
| NPI: | 1780618181 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESCALLETTE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 MILLENNIUM WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ENOLA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170251488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177328131 | ||||||||
| FaxNumber: | 7177328132 | ||||||||
| Practice Location | |||||||||
| Address1: | 2250 MILLENNIUM WAY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | ENOLA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170251488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177328131 | ||||||||
| FaxNumber: | 7177328132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 11/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT014076 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | PT014076 | 01 | PA | PT | OTHER |