Provider Demographics
NPI:1982644589
Name:PICKERING, MICHAEL D (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:PICKERING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 LEWIS LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-9331
Mailing Address - Country:US
Mailing Address - Phone:903-785-3861
Mailing Address - Fax:903-739-8768
Practice Address - Street 1:2875 LEWIS LANE
Practice Address - Street 2:SUITE B
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-9331
Practice Address - Country:US
Practice Address - Phone:903-785-3861
Practice Address - Fax:903-739-8768
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113694225100000X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
7201425OtherAETNA PROVIDER NUMBER
TX84022TOtherBCBS PROVIDER NUMBER
120513OtherSUPERIOR PROVIDER NUMBER