Provider Demographics
NPI:1114651932
Name:STEFUN, MICHELLE (MT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:STEFUN
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BROADWAY UNIT E
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-2767
Mailing Address - Country:US
Mailing Address - Phone:970-343-0822
Mailing Address - Fax:
Practice Address - Street 1:2500 BROADWAY UNIT E
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-2767
Practice Address - Country:US
Practice Address - Phone:970-343-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-16
Last Update Date:2022-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0019201225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist