1407991292 NPI number — MICHELLE MCPHERSON PT

Table of content: MICHELLE MCPHERSON PT (NPI 1407991292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407991292 NPI number — MICHELLE MCPHERSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCPHERSON
Provider First Name:
MICHELLE
Provider Middle Name:
Provider Name Prefix Text:
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:
FOGEL
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407991292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4733
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH COLBY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98384-0733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-769-5944
Provider Business Mailing Address Fax Number:
360-769-5944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4459 SE MILE HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-769-5944
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

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:  PT00007202 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7101264 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122682200 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7208241 . This is a "AETNA PROVDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0151346 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1940506 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 861138313 . This is a "KITSAP PHYSICIANS SERVICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5321FO . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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