Provider Demographics
NPI:1245633668
Name:WILEY, MICHELE (PT DPT PCS)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:WILEY
Suffix:
Gender:F
Credentials:PT DPT PCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19500 SANDRIDGE WAY
Mailing Address - Street 2:SUITE 390 RIVERSIDE OFFICE PARK
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3688
Mailing Address - Country:US
Mailing Address - Phone:703-858-3100
Mailing Address - Fax:
Practice Address - Street 1:19500 SANDRIDGE WAY
Practice Address - Street 2:SUITE 390 RIVERSIDE OFFICE PARK
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3688
Practice Address - Country:US
Practice Address - Phone:703-858-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052032252251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics