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General NPI Number Information
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NPI Number | 1407667165
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Entity Type | Individual
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Provider Name | MICHELLE PATLAN PTA
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Gender | Female
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Dates
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Enumeration Date | 01/14/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 229 HILLCREST PKWY STE 250
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City | CHESAPEAKE
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State | VA
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Zip | 23322-2492
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Country | US
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Telephone | 757-512-5639
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 412307
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City | BOSTON
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State | MA
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Zip | 02241-2307
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Country | US
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Telephone | 914-294-4050
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Fax | 631-760-8306
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | CP039038A
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License Number State | VA
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