1518091701 NPI number — MRS. MICHELE SELLERS ALLARD PT

Table of content: MRS. MICHELE SELLERS ALLARD PT (NPI 1518091701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518091701 NPI number — MRS. MICHELE SELLERS ALLARD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLARD
Provider First Name:
MICHELE
Provider Middle Name:
SELLERS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518091701
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7915 LAKE MANASSAS DRIVE
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-248-0248
Provider Business Mailing Address Fax Number:
571-248-0250

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7915 LAKE MANASSAS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-248-0248
Provider Business Practice Location Address Fax Number:
571-248-0250
Provider Enumeration Date:
03/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  2305204856 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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