Basic Information
| Provider Information | |||||||||
| NPI: | 1558440594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHLBRECHT | ||||||||
| FirstName: | MICHELE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16083 SW UPPER BOONES FERRY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972247736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8002198835 | ||||||||
| FaxNumber: | 5036939699 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 S 12TH AVE STE 5 | ||||||||
| Address2: | |||||||||
| City: | YAKIMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 989023139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094533103 | ||||||||
| FaxNumber: | 5094532057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 10/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00002045 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 79291 | 01 | WA | LABOR & INDUSTRY | OTHER | 0258825 | 01 | WA | WASHINGTON L&I | OTHER | 4497 | 01 | WA | GROUP HEALTH | OTHER | 1477632412 | 05 | WA | MEDICAID | 1558440594 | 05 | WA | MEDICAID | 8335960 | 05 | WA | MEDICAID | P00953685 | 01 | WA | RR MEDICARE | OTHER |