Provider Demographics
NPI:1780618181
Name:LESCALLETTE, MICHAEL C (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:LESCALLETTE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2250 MILLENNIUM WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1488
Mailing Address - Country:US
Mailing Address - Phone:717-732-8131
Mailing Address - Fax:717-732-8132
Practice Address - Street 1:2250 MILLENNIUM WAY
Practice Address - Street 2:SUITE 400
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1488
Practice Address - Country:US
Practice Address - Phone:717-732-8131
Practice Address - Fax:717-732-8132
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT014076225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT014076OtherPT