MEDICARE: MICHELE MARIE HONEYCUTT PT

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
1	225100000X	Physical Therapist	PT00005483	WA

General Provider Information

NPI Number	:	1598834707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELE MARIE HONEYCUTT PT

Provider Business Mailing Address
First Line	:	8411 192ND ST SW
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-6124
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 MONTLAKE BLVD NE
Second Line	:	ROOM 148B
City	:	SEATTLE
State	:	WA
Zip	:	98195-0001
Country	:	US
Telephone Number	:	206-543-1552
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	07/08/2007

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