Provider Demographics
NPI:1619205960
Name:HALL, MICHELLE ANN (LMP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANN
Last Name:HALL
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 3RD AVE STE 450
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3000
Mailing Address - Country:US
Mailing Address - Phone:206-447-2220
Mailing Address - Fax:206-447-2228
Practice Address - Street 1:1227 N 205TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-3214
Practice Address - Country:US
Practice Address - Phone:206-546-2220
Practice Address - Fax:206-546-2228
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60109471225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist