Provider Demographics
NPI:1780803171
Name:HOPKINS, MICHELLE LYN (MPT)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYN
Last Name:HOPKINS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12419 4TH AVE W
Mailing Address - Street 2:5101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6422
Mailing Address - Country:US
Mailing Address - Phone:360-402-9207
Mailing Address - Fax:
Practice Address - Street 1:12419 4TH AVE W
Practice Address - Street 2:5101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6422
Practice Address - Country:US
Practice Address - Phone:360-402-9207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008976225100000X
MD21690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist