Healthcare Provider Details

I. General information

NPI: 1588879332
Provider Name (Legal Business Name): MICHELLE KATHLEEN ESTES LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10904 SE 176TH ST
RENTON WA
98055-5678
US

IV. Provider business mailing address

3923 S 286TH ST
AUBURN WA
98001-1318
US

V. Phone/Fax

Practice location:
  • Phone: 425-255-8100
  • Fax:
Mailing address:
  • Phone: 253-850-8279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA21982
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: