Provider Demographics
NPI:1083845770
Name:DRAKE, MICHELLE LEE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:DRAKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4141
Mailing Address - Country:US
Mailing Address - Phone:907-272-8615
Mailing Address - Fax:907-272-8164
Practice Address - Street 1:2740 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4141
Practice Address - Country:US
Practice Address - Phone:907-272-8615
Practice Address - Fax:907-272-8164
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist