Provider Demographics
NPI:1508944554
Name:TEATER, MICHAEL D (PT, DPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:TEATER
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 SE 192ND AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7415
Mailing Address - Country:US
Mailing Address - Phone:360-210-5440
Mailing Address - Fax:360-210-7731
Practice Address - Street 1:1905 SE 192ND AVE STE 109
Practice Address - Street 2:
Practice Address - City:CAMAS
Practice Address - State:WA
Practice Address - Zip Code:98607-7415
Practice Address - Country:US
Practice Address - Phone:360-210-5440
Practice Address - Fax:360-210-7731
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT10121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1012151Medicaid
02062OtherLABOR & INDUSTRIES
WA9732TEOtherREGENCE B/S
WA4125TEOtherREGENCE B/S
WA5763TEOtherREGENCE B/S
WA8870446OtherMEDICARE
WA0228602OtherDEPT OF L&I
WA8446431OtherDEPT L&I
WA2854TEOtherREGENCE B/S
WA5763TEOtherREGENCE B/S