Provider Demographics
NPI:1891740049
Name:TOWNSHEND, MICHELE SUSAN (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:SUSAN
Last Name:TOWNSHEND
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 1:9419 COPPERTOP LOOP NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110
Mailing Address - Country:US
Mailing Address - Phone:206-842-2428
Mailing Address - Fax:206-842-2890
Practice Address - Street 1:9419 COPPERTOP LOOP NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-2428
Practice Address - Fax:206-842-2890
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA131758OtherDEPT OF LABOR & INDUSTRIE
WA5325648OtherAETNA/LEXINGTON, KY
WA810588134-04OtherKPS HEALTH PLANS
WAT05842OtherREGENCE BLUE SHIELD
WAT05842OtherREGENCE BLUE SHIELD