Provider Demographics
NPI:1396904710
Name:MARCORDES, MICHELLE VERONIQUE (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VERONIQUE
Last Name:MARCORDES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16102 93RD ST E
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:WA
Mailing Address - Zip Code:98390-8258
Mailing Address - Country:US
Mailing Address - Phone:253-334-7339
Mailing Address - Fax:
Practice Address - Street 1:16102 93RD ST E
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-8258
Practice Address - Country:US
Practice Address - Phone:253-334-7339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant