Provider Demographics
NPI:1114481439
Name:WASHBURN, MICHAEL ALLEN JR (MA, BS, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:WASHBURN
Suffix:JR
Gender:M
Credentials:MA, BS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:140 E HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-4112
Mailing Address - Country:US
Mailing Address - Phone:979-864-8441
Mailing Address - Fax:979-848-8944
Practice Address - Street 1:140 E HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-4112
Practice Address - Country:US
Practice Address - Phone:979-864-8441
Practice Address - Fax:979-848-8944
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator