Healthcare Provider Details

I. General information

NPI: 1922348093
Provider Name (Legal Business Name): MICHAEL HARLEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2013
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E LEE HWY
NEW MARKET VA
22844-3103
US

IV. Provider business mailing address

3676 RICHARDSON RD
TIMBERVILLE VA
22853-2611
US

V. Phone/Fax

Practice location:
  • Phone: 540-740-8041
  • Fax:
Mailing address:
  • Phone: 540-333-3748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206697
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: