Provider Demographics
NPI:1376731562
Name:MICHEL, TERI (LMT, CAHE)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:MICHEL
Suffix:
Gender:F
Credentials:LMT, CAHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6083 MERRILL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2049
Mailing Address - Country:US
Mailing Address - Phone:941-240-6134
Mailing Address - Fax:941-240-6134
Practice Address - Street 1:6083 MERRILL ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2049
Practice Address - Country:US
Practice Address - Phone:941-240-6134
Practice Address - Fax:941-240-6134
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA45484225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist