Provider Demographics
NPI:1033718671
Name:DULAY, MICHELLE TABIN (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TABIN
Last Name:DULAY
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 1:1652 W TEXAS ST STE 127
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5952
Mailing Address - Country:US
Mailing Address - Phone:707-742-3179
Mailing Address - Fax:
Practice Address - Street 1:1652 W TEXAS ST STE 127
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5952
Practice Address - Country:US
Practice Address - Phone:707-742-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-24
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83738225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist