Provider Demographics
NPI:1407991292
Name:MCPHERSON, MICHELLE (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MCPHERSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:FOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 4733
Mailing Address - Street 2:
Mailing Address - City:SOUTH COLBY
Mailing Address - State:WA
Mailing Address - Zip Code:98384-0733
Mailing Address - Country:US
Mailing Address - Phone:360-769-5944
Mailing Address - Fax:360-769-5944
Practice Address - Street 1:209 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4265
Practice Address - Country:US
Practice Address - Phone:253-596-3300
Practice Address - Fax:253-596-3301
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007202225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5321FOOtherREGENCE BLUE SHIELD
7208241OtherAETNA PROVDER NUMBER
WA0151346OtherLABOR AND INDUSTRIES
WA7101264Medicaid
1940506OtherUNITED HEALTHCARE
WA861138313OtherKITSAP PHYSICIANS SERVICE
122682200OtherUS DEPT OF LABOR
122682200OtherUS DEPT OF LABOR