Provider Demographics
NPI:1649048307
Name:HARRELL, MICHAELA HUNTER (DPT)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:HUNTER
Last Name:HARRELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 RIDGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:HARPERS FERRY
Mailing Address - State:WV
Mailing Address - Zip Code:25425-5819
Mailing Address - Country:US
Mailing Address - Phone:304-261-3170
Mailing Address - Fax:
Practice Address - Street 1:1125 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-2148
Practice Address - Country:US
Practice Address - Phone:208-265-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-9218225100000X
NCP20798225100000X
WV004693225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist