Provider Demographics
NPI:1467841627
Name:FREY, MICHELLE (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FREY
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 1:120 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 316
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4236
Mailing Address - Country:US
Mailing Address - Phone:989-944-5695
Mailing Address - Fax:
Practice Address - Street 1:120 N MICHIGAN AVE
Practice Address - Street 2:SUITE 316
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4236
Practice Address - Country:US
Practice Address - Phone:989-944-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist