Provider Demographics
NPI:1023365772
Name:PASCALE, MICHELLE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PASCALE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 GALISTEO ST
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2138
Mailing Address - Country:US
Mailing Address - Phone:505-690-9835
Mailing Address - Fax:
Practice Address - Street 1:2074 GALISTEO ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2138
Practice Address - Country:US
Practice Address - Phone:505-690-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM107225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist