Provider Demographics
NPI:1154450120
Name:MICHELSON, BETH NORMA (LMT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:NORMA
Last Name:MICHELSON
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 1:1031 NW 6TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2226
Mailing Address - Country:US
Mailing Address - Phone:352-376-0309
Mailing Address - Fax:
Practice Address - Street 1:1031 NW 6TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2226
Practice Address - Country:US
Practice Address - Phone:352-376-0309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 6973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist