Provider Demographics
NPI:1720119779
Name:FOWLER, MICHELE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:FOWLER
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 1:2227 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5519
Mailing Address - Country:US
Mailing Address - Phone:425-643-2928
Mailing Address - Fax:425-865-0224
Practice Address - Street 1:2227 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5519
Practice Address - Country:US
Practice Address - Phone:425-643-2928
Practice Address - Fax:425-865-0224
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT9532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8402729Medicaid
WA8806831Medicare ID - Type UnspecifiedMEDICARE