Provider Demographics
NPI:1316965460
Name:MICHAUD, DAWN MARIE (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-1900
Mailing Address - Country:US
Mailing Address - Phone:320-251-2700
Mailing Address - Fax:320-656-7115
Practice Address - Street 1:1406 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-1900
Practice Address - Country:US
Practice Address - Phone:320-251-2700
Practice Address - Fax:320-656-7115
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP31282OtherHEALTHPARTNERS
MN264M1NOOtherBLUE CROSS BLUE SHIELD OF MN
MN6406600OtherMEDICA
MN6406600OtherSELECT CARE
MN123H3MIOtherBCBS
MN131219700Medicaid
MN6406600OtherMEDICA
MN650001495Medicare PIN
MNP00339272Medicare PIN