Active NPI
Michelle Fetrick, DPT
- Physical Therapist
- Olympia, WA
National Provider Identifier
1417378423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 60113648
- Practice address
- 4001 Harrison Ave NW
Ste 102
Olympia, WA 98502-5084 - Phone
- (360) 956-3627
- Fax
- (360) 740-0555
- NPI assigned
- Dec 17, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 60113648 | WA | Primary |
Addresses
Primary practice location
4001 Harrison Ave NW
Ste 102
Olympia, WA 98502-5084
Mailing address
PO Box 89
Chehalis, WA 98532-0089
Phone (360) 740-0888
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 60113648 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387238400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447113600000",
"number": "1417378423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 89",
"city": "CHEHALIS",
"state": "WA",
"postal_code": "985320089",
"telephone_number": "360-740-0888",
"fax_number": "360-740-0555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4001 HARRISON AVE NW",
"address_2": "STE 102",
"city": "OLYMPIA",
"state": "WA",
"postal_code": "985025084",
"telephone_number": "360-956-3627",
"fax_number": "360-740-0555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FETRICK",
"first_name": "MICHELLE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-12-17",
"last_updated": "2015-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT 60113648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olympia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.