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General NPI Number Information
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NPI Number | 1528464849
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Entity Type | Individual
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Provider Name | MICHAEL JOHN BAGBY DPT
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Gender | Male
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Dates
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Enumeration Date | 11/13/2014
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Last Update Date | 11/13/2014
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Provider Practice Location Address
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Address Line | 6101 200TH ST SW STE 208
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City | LYNNWOOD
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State | WA
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Zip | 98036-6077
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Country | US
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Telephone | 425-778-2325
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Fax | 425-778-7692
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Provider Business Mailing Address
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Address Line | PO BOX 156
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City | COUPEVILLE
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State | WA
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Zip | 98239-0156
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Country | US
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Telephone | 360-269-1723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60478657
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License Number State |
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