Provider Demographics
NPI:1295883676
Name:FREMONT, MICHELE M (PT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:M
Last Name:FREMONT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19007 61ST AVE NE #5
Mailing Address - Street 2:ATTN HPI
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-6300
Mailing Address - Country:US
Mailing Address - Phone:360-435-8989
Mailing Address - Fax:360-403-8347
Practice Address - Street 1:19007 61ST AVE NE #5
Practice Address - Street 2:ATTN HPI
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-6300
Practice Address - Country:US
Practice Address - Phone:360-435-8989
Practice Address - Fax:360-403-8347
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005785225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA44097OtherDEPT LABOR & INDUSTRIES
192605100OtherUS DEPT OF LABOR OWCP
WA8341893Medicaid
P537085Medicare UPIN
WA8341893Medicaid