Provider Demographics
NPI:1336163393
Name:CANTER, MISCHELLE J (PT)
Entity Type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:J
Last Name:CANTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 HIGH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3321
Mailing Address - Country:US
Mailing Address - Phone:757-673-5689
Mailing Address - Fax:757-673-5678
Practice Address - Street 1:3300 HIGH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3321
Practice Address - Country:US
Practice Address - Phone:757-673-5689
Practice Address - Fax:757-673-5678
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008447O94Medicare ID - Type Unspecified