Provider Demographics
NPI:1154988368
Name:HINOJOSA, MICHELLE BRAGAT (LMT)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:BRAGAT
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BROADWAY E APT 545
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5386
Mailing Address - Country:US
Mailing Address - Phone:707-704-7384
Mailing Address - Fax:
Practice Address - Street 1:4519 1/2 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4515
Practice Address - Country:US
Practice Address - Phone:206-632-5074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60957634225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist