Provider Demographics
NPI:1700276862
Name:WOODHOUSE, MICHAEL LEE (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEE
Last Name:WOODHOUSE
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W 21ST ST
Mailing Address - Street 2:SUITE F, NO. 312
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-2200
Mailing Address - Country:US
Mailing Address - Phone:757-628-1095
Mailing Address - Fax:757-628-1096
Practice Address - Street 1:222 W 21ST ST
Practice Address - Street 2:SUITE F, NO. 312
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23517-2200
Practice Address - Country:US
Practice Address - Phone:757-628-1095
Practice Address - Fax:757-628-1096
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260000922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer