Provider Demographics
NPI:1306360300
Name:AMOS, MICHELLE RENEE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:AMOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 CORPORATE PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2279
Mailing Address - Country:US
Mailing Address - Phone:434-525-4851
Mailing Address - Fax:434-509-1695
Practice Address - Street 1:1111 CORPORATE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2279
Practice Address - Country:US
Practice Address - Phone:434-525-4851
Practice Address - Fax:434-509-1695
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic