Provider Demographics
NPI:1376696922
Name:MCMICHAEL, ROBERTA L (PT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:L
Last Name:MCMICHAEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 5TH AVE NE
Mailing Address - Street 2:STE 201 WEST
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7025
Mailing Address - Country:US
Mailing Address - Phone:206-287-6400
Mailing Address - Fax:206-341-1801
Practice Address - Street 1:10601 5TH AVE NE
Practice Address - Street 2:STE 201 WEST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7025
Practice Address - Country:US
Practice Address - Phone:206-287-6400
Practice Address - Fax:206-341-1801
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMC2662OtherBLUE SHIELD #
WAP00238672OtherRAILROAD MC#
WA8395592Medicaid
WAUS1051963OtherAETNA SPECIALIST PIN
WA0039585OtherLABOR AND INDUSTRIES #
WA0039585OtherLABOR AND INDUSTRIES #
WAUS1051963OtherAETNA SPECIALIST PIN