Provider Demographics
NPI:1407991292
Name:MCPHERSON, MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 4733
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0733
Mailing Address - Country:US
Mailing Address - Phone:360-769-5944
Mailing Address - Fax:360-769-5944
Practice Address - Street 1:4459 SE MILE HILL DR
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3908
Practice Address - Country:US
Practice Address - Phone:360-769-5944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101264Medicaid
122682200OtherUS DEPT OF LABOR
7208241OtherAETNA PROVDER NUMBER
WA0151346OtherLABOR AND INDUSTRIES
1940506OtherUNITED HEALTHCARE
WA861138313OtherKITSAP PHYSICIANS SERVICE
WA5321FOOtherREGENCE BLUE SHIELD
122682200OtherUS DEPT OF LABOR