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General NPI Number Information
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NPI Number | 1366658338
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Entity Type | Individual
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Provider Name | MICHELLE SUSANN SHEGOGUE MSPT
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10401 SPOTSYLVANIA AVE SUITE 201
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-8606
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Country | US
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Telephone | 540-741-3770
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Fax | 540-741-3775
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Provider Business Mailing Address
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Address Line | 8494 GRAY FOX LN
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City | KING GEORGE
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State | VA
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Zip | 22485-3571
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Country | US
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Telephone | 540-775-4991
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204825
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License Number State | VA
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