Provider Demographics
NPI:1972993301
Name:KWOK, MICHELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:KWOK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4176
Mailing Address - Country:US
Mailing Address - Phone:541-848-8607
Mailing Address - Fax:971-925-6807
Practice Address - Street 1:1554 NE 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4240
Practice Address - Country:US
Practice Address - Phone:541-848-8607
Practice Address - Fax:971-925-6807
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR15592172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist