Provider Demographics
NPI:1558440594
Name:AHLBRECHT, MICHELE ANN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:AHLBRECHT
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 1:16083 SW UPPER BOONES FERRY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7736
Mailing Address - Country:US
Mailing Address - Phone:800-219-8835
Mailing Address - Fax:503-693-9699
Practice Address - Street 1:307 S 12TH AVE STE 5
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3139
Practice Address - Country:US
Practice Address - Phone:509-453-3103
Practice Address - Fax:509-453-2057
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA79291OtherLABOR & INDUSTRY
WA0258825OtherWASHINGTON L&I
WA4497OtherGROUP HEALTH
WA1477632412Medicaid
WA1558440594Medicaid
WA8335960Medicaid
WAP00953685OtherRR MEDICARE
WA79291OtherLABOR & INDUSTRY
WAG8888079Medicare PIN
WA8335960Medicaid