Provider Demographics
NPI:1396376323
Name:RODARTE, MICHAELA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHAELA
Middle Name:
Last Name:RODARTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:RODARTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2650 MAYA WAY
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5393
Mailing Address - Country:US
Mailing Address - Phone:970-275-3688
Mailing Address - Fax:
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3648
Practice Address - Country:US
Practice Address - Phone:970-216-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO-0022151225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist