Provider Demographics
NPI:1619110699
Name:WOODSON, MICHELLE G (LICENSED PHYSICAL TH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:G
Last Name:WOODSON
Suffix:
Gender:F
Credentials:LICENSED PHYSICAL TH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5286 ALEXANDER ROAD
Mailing Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC.
Mailing Address - City:DUBLIN
Mailing Address - State:VA
Mailing Address - Zip Code:24084
Mailing Address - Country:US
Mailing Address - Phone:540-674-6400
Mailing Address - Fax:540-674-6055
Practice Address - Street 1:5286 ALEXANDER ROAD
Practice Address - Street 2:HEARTLAND REHABILITATION SERVICES OF VIRGINIA, INC.
Practice Address - City:DUBLIN
Practice Address - State:VA
Practice Address - Zip Code:24084
Practice Address - Country:US
Practice Address - Phone:540-674-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306602516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant