Provider Demographics
NPI:1912961681
Name:NEWSOM, MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2020
Mailing Address - Country:US
Mailing Address - Phone:804-391-5012
Mailing Address - Fax:804-368-1528
Practice Address - Street 1:301 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2020
Practice Address - Country:US
Practice Address - Phone:804-391-5012
Practice Address - Fax:804-368-1528
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7630753OtherAETNA
143281OtherAN/HK
184946OtherANTHEM PPO
429180OtherMAMSI
255534OtherSOUTHERN HEALTH
6404543OtherUNITED HEALTHCARE
183574OtherANTHEM PPO
7630753OtherAETNA HMO
184946OtherHEALTHKEEPERS
412143526OtherPHCS
54960OtherMEDICAID HMO
412143526OtherCIGNA
6400713OtherUNITED HEALTHCARE
329180OtherMAMSI
255534OtherSOUTHERN HEALTH
009173R75Medicare ID - Type Unspecified