Provider Demographics
NPI:1952624421
Name:MARMETO, MICHELLE RAGAS
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAGAS
Last Name:MARMETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 NW 6TH STREET
Mailing Address - Street 2:#7 APARTMENT
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1552
Mailing Address - Country:US
Mailing Address - Phone:541-226-4277
Mailing Address - Fax:
Practice Address - Street 1:950 PACIFIC AVE FL 8
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-4400
Practice Address - Country:US
Practice Address - Phone:253-274-4600
Practice Address - Fax:253-274-4601
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6168225100000X
WA60130841225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist