Provider Demographics
NPI:1215529482
Name:PAPE, MICHAEL TANNER (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TANNER
Last Name:PAPE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2972
Mailing Address - Country:US
Mailing Address - Phone:325-439-5670
Mailing Address - Fax:325-437-1827
Practice Address - Street 1:1725 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2972
Practice Address - Country:US
Practice Address - Phone:325-439-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1342585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1342585OtherCOMMERCIAL INSURANCE
TX1342585Medicaid