Individual
MICHELE R IVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
11-03404
KS
225100000X
Physical Therapist
Primary
2005003641
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
35214014
BLUE CROSS & BLUE SHIELD
MO
Enumeration date
01/17/2006
Last updated
07/13/2026
Update your record
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