Provider Demographics
NPI:1740297639
Name:TONKINSON, MICHELLE KATHRYN (BS PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHRYN
Last Name:TONKINSON
Suffix:
Gender:F
Credentials:BS PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KATHRYN
Other - Last Name:MAECKELBERGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS PT
Mailing Address - Street 1:2001 BUTTERFIELD RD STE 1600
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1211
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 NE PARK PLAZA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5895
Practice Address - Country:US
Practice Address - Phone:360-253-8285
Practice Address - Fax:360-883-0806
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAO9I010OtherREGENCE BCBS
OR508460001OtherREGENCE BCBS
WAO9I010OtherREGENCE BCBS