Provider Demographics
NPI:1770832164
Name:HUFFINGTON, MICHAEL KEENAN (DPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KEENAN
Last Name:HUFFINGTON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:KATHLEEN
Other - Last Name:HUFFINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 ORCHARD ST W STE 100
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6610
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:5814 GRAHAM AVE STE 101
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:WA
Practice Address - Zip Code:98390-2728
Practice Address - Country:US
Practice Address - Phone:951-696-9353
Practice Address - Fax:951-973-7216
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207598225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist