Provider Demographics
NPI:1265717201
Name:GILPIN, MICHELLE ELAINE (DPT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELAINE
Last Name:GILPIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ELAINE
Other - Last Name:GILPIN MICHALOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 NE LAURELHURST PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2655
Mailing Address - Country:US
Mailing Address - Phone:503-866-5232
Mailing Address - Fax:
Practice Address - Street 1:1940 NW 24TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2786
Practice Address - Country:US
Practice Address - Phone:503-866-5232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6645225100000X
WAPT60255809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500639302Medicaid
WA1265717201Medicaid
WA1265717201Medicaid
OR500639302Medicaid
WAR163608Medicare PIN