Provider Demographics
NPI:1598513194
Name:DEARMENT, MICHELE LANDRY (LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:LANDRY
Last Name:DEARMENT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10600A CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-3432
Mailing Address - Country:US
Mailing Address - Phone:703-686-4092
Mailing Address - Fax:
Practice Address - Street 1:10600A CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-3432
Practice Address - Country:US
Practice Address - Phone:703-686-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019015196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist