Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT00005418 | WA |
N | 225100000X | Physical Therapist | PT5418 | WA |
N | 2251S0007X | Physical Therapist - Sports | PT00005418 | WA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT00005418 | WA |
NPI | 1093897613 |
---|---|
Provider Name | Mr. Michael Andrew Egbert |
First Address | Bonney Lake, WA 98391-6302 |
Second Address | Bonney Lake, WA 98391-6302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 03/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171896 | L&I PROVIDER NO. (01) | WA |
246114 | L&I (01) | WA |
7126303 | (05) | WA |
7421EG | BLUE SHILD BL (01) | WA |
8543712 | (05) | WA |
EG4516 | BLUE SHIELD PROV. NO. (01) | WA |
G889917 | (02) | WA |
GAB38574 | (02) | WA |
P00061737 | MEDICARE RAILROAD (01) | WA |