Provider Demographics
NPI:1487312674
Name:MESSERLY, PAUL ROBERT
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:MESSERLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 TUNBRIDGE RD APT 3
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-5324
Mailing Address - Country:US
Mailing Address - Phone:715-571-4835
Mailing Address - Fax:
Practice Address - Street 1:1422 TUNBRIDGE RD APT 3
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5324
Practice Address - Country:US
Practice Address - Phone:715-571-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2021-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306605683225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant