Provider Demographics
NPI:1386214153
Name:MORALDE, MICHELLE ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:MORALDE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 GILES CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-3422
Mailing Address - Country:US
Mailing Address - Phone:757-284-5896
Mailing Address - Fax:
Practice Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6601
Practice Address - Country:US
Practice Address - Phone:757-395-1975
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist