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Individual
MR. MICHAEL G VAN PEVENAGE
Active
Individual
MR. MICHAEL G VAN PEVENAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00006484
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0205378
LABOR AND INDUSTRIES
WA
05
—
7125768
—
WA
01
—
DF0622
PALMETTO
WA
Enumeration date
12/26/2006
Last updated
10/19/2012
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