Provider Demographics
NPI:1538128657
Name:KANE, MICHAEL D (MPT MOMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:KANE
Suffix:
Gender:M
Credentials:MPT MOMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 W LINCOLN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902
Mailing Address - Country:US
Mailing Address - Phone:509-573-4816
Mailing Address - Fax:509-573-4825
Practice Address - Street 1:2006 W LINCOLN AVE
Practice Address - Street 2:STE A
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:509-573-4816
Practice Address - Fax:509-573-4825
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist