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NPI Code Detail

MEDICARE: MS. MICHELLE LYNN PEREIRA DPT

MEDICARE: MS. MICHELLE LYNN PEREIRA DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant2306603165VA

General Provider Information

NPI Number : 1538443759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE LYNN PEREIRA DPT
Provider Business Mailing Address
First Line : 1628 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3062
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1628 OLD DONATION PKWY
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-3062
Country : US
Telephone Number : 757-496-8001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2011
Last Update Date : 10/06/2011

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