Provider Demographics
NPI:1295162659
Name:TICHENOR, MICHAELA
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5950 6TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-3317
Mailing Address - Country:US
Mailing Address - Phone:206-805-1930
Mailing Address - Fax:206-805-1931
Practice Address - Street 1:5950 6TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-3317
Practice Address - Country:US
Practice Address - Phone:206-805-1930
Practice Address - Fax:206-805-1931
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023168225100000X
NY036897225100000X
WAPT60794381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist