Provider Demographics
NPI:1154315216
Name:BATES, MICHAEL P (PT CCM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BATES
Suffix:
Gender:M
Credentials:PT CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 YELLOW WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-7126
Mailing Address - Country:US
Mailing Address - Phone:304-255-2376
Mailing Address - Fax:304-255-7120
Practice Address - Street 1:9 YELLOW WOOD WAY
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-7126
Practice Address - Country:US
Practice Address - Phone:304-255-2376
Practice Address - Fax:304-255-7120
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001710560OtherBCBS
WV7041257OtherAETNA
WV0157003000Medicaid
WVP00103347OtherRAIL ROAD MEDICARE
WV1516805OtherUMWA
WV55074417400OtherWORKERS COMP
WV55074417400OtherWORKERS COMP
WV0836491Medicare PIN