Provider Demographics
NPI:1861064362
Name:MEHFOUD, MICHELLE LUEBEHUSEN (MSPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LUEBEHUSEN
Last Name:MEHFOUD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DUNOON CT
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2619
Mailing Address - Country:US
Mailing Address - Phone:804-943-4979
Mailing Address - Fax:
Practice Address - Street 1:3335 S CRATER RD STE 200
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9214
Practice Address - Country:US
Practice Address - Phone:804-765-6660
Practice Address - Fax:804-765-5412
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305004301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist