Provider Demographics
NPI:1437229721
Name:HUCKE, MICKIE (PT)
Entity Type:Individual
Prefix:
First Name:MICKIE
Middle Name:
Last Name:HUCKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICKIE
Other - Middle Name:
Other - Last Name:GABRIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 731269
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-0060
Mailing Address - Country:US
Mailing Address - Phone:253-840-2313
Mailing Address - Fax:253-840-6340
Practice Address - Street 1:11019 CANYON RD E
Practice Address - Street 2:SUITE C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3001
Practice Address - Country:US
Practice Address - Phone:253-286-3600
Practice Address - Fax:253-286-3444
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA199082OtherDEPT OF LABOR & INDUSTRY
WA7605719OtherAETNA
WA3912HUOtherREGENCE BLUE SHIELD
WA8906542OtherCRIME VICTIMS
WA8430464Medicaid
WA199082OtherDEPT OF LABOR & INDUSTRY