Provider Demographics
NPI:1396795993
Name:GALE, MICHAEL DON (PT)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DON
Last Name:GALE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 W KENNEWICK AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7764
Mailing Address - Country:US
Mailing Address - Phone:509-735-4343
Mailing Address - Fax:509-736-5414
Practice Address - Street 1:7513 W KENNEWICK AVE
Practice Address - Street 2:SUITE A
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7764
Practice Address - Country:US
Practice Address - Phone:509-735-4343
Practice Address - Fax:509-736-5414
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8341158Medicaid
WA0198073OtherL&I
WA1055960147OtherBLUECROSS
WA8341158Medicaid