Provider Demographics
NPI:1518542752
Name:D'ASCANIO, MICHELLE LEE (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:D'ASCANIO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-1568
Mailing Address - Country:US
Mailing Address - Phone:508-596-2704
Mailing Address - Fax:
Practice Address - Street 1:111 HUNTOON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:MA
Practice Address - Zip Code:01542-1301
Practice Address - Country:US
Practice Address - Phone:508-892-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6817208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation