Provider Demographics
NPI:1376528059
Name:ZIEGLER, MICHELLE M (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 BORST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-1404
Mailing Address - Country:US
Mailing Address - Phone:360-807-0577
Mailing Address - Fax:360-807-0574
Practice Address - Street 1:2020 BORST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-1404
Practice Address - Country:US
Practice Address - Phone:360-807-0577
Practice Address - Fax:360-807-0574
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007656225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8344814Medicaid
8850915Medicare ID - Type Unspecified