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General NPI Number Information
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NPI Number | 1861854812
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Entity Type | Organization
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Legal Business Name | VIRGINIA BEACH PHYSICAL THERAPY & WELLNESS , PLLC
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 02/04/2021
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Provider Practice Location Address
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Address Line | 2126 GREAT NECK SQ
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2202
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Country | US
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Telephone | 757-578-2197
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Fax | 757-578-2330
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Provider Business Mailing Address
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Address Line | 2126 GREAT NECK SQ
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-2202
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Country | US
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Telephone | 757-578-2197
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Fax | 757-578-2330
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. MICHELE MARTIN NIELSEN
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Credential | DPT
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Telephone | 757-578-2197
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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 | 2305204696
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License Number State | VA
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