Provider Demographics
NPI:1518091701
Name:ALLARD, MICHELE SELLERS (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:SELLERS
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 LAKE MANASSAS DRIVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:571-248-0248
Mailing Address - Fax:571-248-0250
Practice Address - Street 1:7915 LAKE MANASSAS DRIVE
Practice Address - Street 2:SUITE 305
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155
Practice Address - Country:US
Practice Address - Phone:571-248-0248
Practice Address - Fax:571-248-0250
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204856225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA496675Medicare ID - Type Unspecified