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NPI Code Detail

MEDICARE: MICHELLE DOUGLAS

MEDICARE: MICHELLE DOUGLAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist2482OK
2225100000XPhysical Therapist1148497TX

General Provider Information

NPI Number : 1417167958
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE DOUGLAS
Provider Business Mailing Address
First Line : 912 N BRYAN ST
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-3606
Country : US
Telephone Number : 940-867-4254
Fax Number :
Provider Business Practice Location Address
First Line : 3701 E MAIN ST
Second Line :
City : WEATHERFORD
State : OK
Zip : 73096-3309
Country : US
Telephone Number : 940-549-8787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 01/29/2026

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Directions to “ MICHELLE DOUGLAS ” Practice Location

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