Provider Demographics
NPI:1528196698
Name:VIESSELMAN, MICHELLE A (LMT, NCTMB, MMP, CLT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:VIESSELMAN
Suffix:
Gender:F
Credentials:LMT, NCTMB, MMP, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 W QUAIL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-2746
Mailing Address - Country:US
Mailing Address - Phone:702-643-1202
Mailing Address - Fax:702-364-1475
Practice Address - Street 1:2860 E FLAMINGO RD
Practice Address - Street 2:SUITE A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5271
Practice Address - Country:US
Practice Address - Phone:702-731-2128
Practice Address - Fax:866-378-3528
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist