Provider Demographics
NPI:1508381948
Name:BROWN, MICHELLE ALEXANDRIA (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ALEXANDRIA
Last Name:BROWN
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 1:2431 ESTANCIA BLVD STE A2
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2608
Mailing Address - Country:US
Mailing Address - Phone:813-465-4097
Mailing Address - Fax:
Practice Address - Street 1:2431 ESTANCIA BLVD STE A2
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2608
Practice Address - Country:US
Practice Address - Phone:813-465-4097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty