Provider Demographics
NPI:1912961681
Name:NEWSOM, MICHELLE (MPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23005-2020
Mailing Address - Country:US
Mailing Address - Phone:804-391-5012
Mailing Address - Fax:804-368-1528
Practice Address - Street 1:301 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:VA
Practice Address - Zip Code:23005-2020
Practice Address - Country:US
Practice Address - Phone:804-391-5012
Practice Address - Fax:804-368-1528
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
412143526OtherCIGNA
6404543OtherUNITED HEALTHCARE
184946OtherHEALTHKEEPERS
255534OtherSOUTHERN HEALTH
412143526OtherPHCS
54960OtherMEDICAID HMO
143281OtherAN/HK
184946OtherANTHEM PPO
6400713OtherUNITED HEALTHCARE
429180OtherMAMSI
7630753OtherAETNA HMO
183574OtherANTHEM PPO
7630753OtherAETNA
329180OtherMAMSI
255534OtherSOUTHERN HEALTH
009173R75Medicare ID - Type Unspecified