Provider Demographics
NPI:1396849741
Name:HATHAWAY, MICHAEL D (DPT ATC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:DPT ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 CUTSHAW AVE
Mailing Address - Street 2:SUITE 299
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:804-340-1193
Mailing Address - Fax:804-340-1930
Practice Address - Street 1:3805 CUTSHAW AVE
Practice Address - Street 2:SUITE 299
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-340-1193
Practice Address - Fax:804-340-1930
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204723225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09247Medicare PIN
C06575Medicare PIN
VA012384R75Medicare PIN
VA012447R47Medicare PIN