Provider Demographics
NPI:1629212139
Name:TALBOT, MICHELLE DENISE (LMT, NCTMB)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:TALBOT
Suffix:
Gender:F
Credentials:LMT, NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 ARKENDALE ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1238
Mailing Address - Country:US
Mailing Address - Phone:703-763-3106
Mailing Address - Fax:703-763-3107
Practice Address - Street 1:3002 ARKENDALE ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1238
Practice Address - Country:US
Practice Address - Phone:703-763-3106
Practice Address - Fax:703-763-3107
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006655730359225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629212139OtherNPI
VA506471-06OtherNATIONAL CERTIFICATION NUMBER