Provider Demographics
NPI:1154676963
Name:POLAS, MICHELLE LYNN (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:POLAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LYNN
Other - Last Name:OAKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:8100 SW NYBERG ST STE 130
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8375
Mailing Address - Country:US
Mailing Address - Phone:503-885-8677
Mailing Address - Fax:503-885-0676
Practice Address - Street 1:8100 SW NYBERG ST STE 130
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8375
Practice Address - Country:US
Practice Address - Phone:503-885-8677
Practice Address - Fax:503-885-0676
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist