Provider Demographics
NPI:1508097254
Name:GAITHER, MICHAELA PATRICE (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:PATRICE
Last Name:GAITHER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 E PLACITA MAPACHE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-3929
Mailing Address - Country:US
Mailing Address - Phone:520-243-0518
Mailing Address - Fax:
Practice Address - Street 1:5501 N ORACLE RD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3850
Practice Address - Country:US
Practice Address - Phone:520-243-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ8523OtherLICENSE NUMBER
AZ448880Medicaid