Healthcare Provider Details

I. General information

NPI: 1083002711
Provider Name (Legal Business Name): DR. MICHELLE THANH CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 HARWICH CT APT 130
ALEXANDRIA VA
22311-5769
US

IV. Provider business mailing address

5775 HARWICH CT APT 130
ALEXANDRIA VA
22311-5769
US

V. Phone/Fax

Practice location:
  • Phone: 703-785-7360
  • Fax:
Mailing address:
  • Phone: 703-785-7360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2305207920
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: