Healthcare Provider Details

I. General information

NPI: 1134354707
Provider Name (Legal Business Name): C MICHELLE HOGBIN MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 12/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 GARDNER PARK DR
GAINESVILLE VA
20155-3414
US

IV. Provider business mailing address

14535 JOHN MARSHALL HWY STE 203
GAINESVILLE VA
20155-4025
US

V. Phone/Fax

Practice location:
  • Phone: 703-753-1005
  • Fax: 703-753-2207
Mailing address:
  • Phone: 703-753-0261
  • Fax: 703-743-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305006069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: