Connor Mickelson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

60956900 Issued in WA

Practice address

3121 E Madison St Ste 201
Seattle, WA 98112-4259

Phone

(206) 324-5389

Fax

(206) 324-5391

NPI assigned

Aug 14, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Valley Medical Group-Renton

  • General Acute Care Hospital
  • Renton, WA
  • NPI 1619209574
  Medicare reassignment NPD
• Therapeutic Associates Inc

  • Physical Therapist
  • Bothell, WA
  • NPI 1114376563
  NPD (past)
• Therapeutic Associates Inc

  • Physical Therapist
  • Portland, OR
  • NPI 1700862000
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565740800000",
    "number": "1972159945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "503-443-6156",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3121 E MADISON ST STE 201",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981124259",
            "telephone_number": "206-324-5389",
            "fax_number": "206-324-5391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKELSON",
        "first_name": "CONNOR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-14",
        "last_updated": "2019-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60956900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Irene Marion Michon, LMHC
• Jared D. Michonski, PH.D.
• Mary Elizabeth Micikas, FNP
• Andrea Mickelsen, RN
• Adrianna Cherie Mickelson, M.D.
• Ashley Middagh
• Middle Way Internal Medicine, PLLC
• Allison Paige Middleman, ND
• Erica Middleton
• Kimberley Woodhouse Middleton, MD

• Physical Therapist in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.