Provider Demographics
NPI:1972746329
Name:TRATHEN, MICHAEL GEORGE (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GEORGE
Last Name:TRATHEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 NE 20TH ST
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-3023
Mailing Address - Country:US
Mailing Address - Phone:954-899-1144
Mailing Address - Fax:
Practice Address - Street 1:2151 E COMMERCIAL BLVD.
Practice Address - Street 2:SUITE 305
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-446-9178
Practice Address - Fax:954-707-6302
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist