Provider Demographics
NPI:1437514635
Name:CARROLL, MICHELLE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NASHWAUK
Mailing Address - State:MN
Mailing Address - Zip Code:55769-1103
Mailing Address - Country:US
Mailing Address - Phone:218-966-7089
Mailing Address - Fax:
Practice Address - Street 1:113 1ST ST
Practice Address - Street 2:
Practice Address - City:NASHWAUK
Practice Address - State:MN
Practice Address - Zip Code:55769-1103
Practice Address - Country:US
Practice Address - Phone:218-966-7089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist