Provider Demographics
NPI:1144578592
Name:CHEVALIER, MICHAEL B (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:B
Last Name:CHEVALIER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:CHEVALIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:1 PARK WEST CIR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-5551
Mailing Address - Country:US
Mailing Address - Phone:703-400-4152
Mailing Address - Fax:
Practice Address - Street 1:1 PARK WEST CIR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-5551
Practice Address - Country:US
Practice Address - Phone:703-400-4152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603371225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant