Provider Demographics
NPI:1043735301
Name:DORBECK, MICHELE LYNNE (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LYNNE
Last Name:DORBECK
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 1:1850 EAST 53RD STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807
Mailing Address - Country:US
Mailing Address - Phone:309-314-3587
Mailing Address - Fax:
Practice Address - Street 1:1850 E 53RD ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2784
Practice Address - Country:US
Practice Address - Phone:309-314-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA225700000XOtherMASSAGE THERAPY