Provider Demographics
NPI:1366677288
Name:LEVELL, MICHELLE MAE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MAE
Last Name:LEVELL
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 1:105 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:ELECTRA
Mailing Address - State:TX
Mailing Address - Zip Code:76360-1447
Mailing Address - Country:US
Mailing Address - Phone:940-632-0558
Mailing Address - Fax:
Practice Address - Street 1:221 W ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:ELECTRA
Practice Address - State:TX
Practice Address - Zip Code:76360-2437
Practice Address - Country:US
Practice Address - Phone:940-632-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT038536225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXMT038536OtherMASSAGE THERAPIST LICENSE NUMBER