Provider Demographics
NPI:1861548596
Name:HALL, MICHELLE L (CMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:HALL
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3796 TOWNE POINT RD APT G
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-2564
Mailing Address - Country:US
Mailing Address - Phone:757-966-5191
Mailing Address - Fax:
Practice Address - Street 1:3796 TOWNE POINT RD APT G
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2564
Practice Address - Country:US
Practice Address - Phone:757-966-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861548596Medicare ID - Type UnspecifiedMEDICARE NPI