Provider Demographics
NPI:1801006994
Name:GILL, MICHELLE (RPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 113394
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-3394
Mailing Address - Country:US
Mailing Address - Phone:907-334-9002
Mailing Address - Fax:907-334-9320
Practice Address - Street 1:6613 BRAYTON DR
Practice Address - Street 2:SUITE A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2127
Practice Address - Country:US
Practice Address - Phone:907-334-9002
Practice Address - Fax:907-334-9320
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16092251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT2352Medicaid