Provider Demographics
NPI:1942587712
Name:MURPHY, MICHAELA R (PTA)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:R
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-1611
Mailing Address - Country:US
Mailing Address - Phone:540-921-1306
Mailing Address - Fax:540-921-1308
Practice Address - Street 1:203 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1611
Practice Address - Country:US
Practice Address - Phone:540-921-1306
Practice Address - Fax:540-921-1308
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306603153225200000X
WV001655225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant