Provider Demographics
NPI:1902998065
Name:FORSGREN, MICHAEL (MSPT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:FORSGREN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18208 LAUREL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4029
Mailing Address - Country:US
Mailing Address - Phone:714-618-2916
Mailing Address - Fax:
Practice Address - Street 1:18208 LAUREL VIEW DR
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4029
Practice Address - Country:US
Practice Address - Phone:714-618-2916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00009751225100000X
CAPT27916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist