Provider Demographics
NPI:1699917393
Name:THOMAS, MICHELLE DAVIDSON (PT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DAVIDSON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LARA
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4122 FACTORIA BLVD SE STE 401
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5259
Mailing Address - Country:US
Mailing Address - Phone:425-562-1920
Mailing Address - Fax:717-547-1037
Practice Address - Street 1:4122 FACTORIA BLVD SE STE 401
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-5259
Practice Address - Country:US
Practice Address - Phone:425-562-1920
Practice Address - Fax:717-547-1037
Is Sole Proprietor?:No
Enumeration Date:2009-03-27
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35559225100000X
WAPT60655153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist