Provider Demographics
NPI:1760363147
Name:PACHECO, MIGUEL (DPT)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:PACHECO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 GOODES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-5322
Mailing Address - Country:US
Mailing Address - Phone:434-917-1403
Mailing Address - Fax:
Practice Address - Street 1:1554 GOODES FERRY RD
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-5322
Practice Address - Country:US
Practice Address - Phone:434-917-1403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216450225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty