Provider Demographics
NPI:1295896553
Name:LOUMEAU, MICHAEL CYRIL (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:CYRIL
Last Name:LOUMEAU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1913
Mailing Address - Country:US
Mailing Address - Phone:757-464-3000
Mailing Address - Fax:
Practice Address - Street 1:401 GRANBY ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1913
Practice Address - Country:US
Practice Address - Phone:757-464-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291422225100000X
VA23050062402251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ35172Medicare UPIN
VA00W587P01Medicare ID - Type UnspecifiedINDIVIDUAL