Provider Demographics
NPI:1336493154
Name:MORRIS, MICHELLE RENESE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENESE
Last Name:MORRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25876 THE OLD RD # 91
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1711
Mailing Address - Country:US
Mailing Address - Phone:661-492-3757
Mailing Address - Fax:
Practice Address - Street 1:1756 W AVENUE J12 APT 205
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4654
Practice Address - Country:US
Practice Address - Phone:661-670-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37598225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA37598OtherCALIF MASSAGE THERAPY COUNCIL