Provider Demographics
NPI:1972551505
Name:JENNINGS, MICHAEL H JR (MSPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:H
Last Name:JENNINGS
Suffix:JR
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 118TH AVE SE
Mailing Address - Street 2:STE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3875
Mailing Address - Country:US
Mailing Address - Phone:425-450-9474
Mailing Address - Fax:425-452-0704
Practice Address - Street 1:14800 STARFIRE WAY
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-8502
Practice Address - Country:US
Practice Address - Phone:206-267-7811
Practice Address - Fax:206-267-7813
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8342099Medicaid
S57496Medicare UPIN
WAG8895658Medicare PIN
WA8342099Medicaid