Provider Demographics
NPI:1558685230
Name:RONDEAU, MICHELLE LEIGH (LMP)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LEIGH
Last Name:RONDEAU
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 120TH PL NE
Mailing Address - Street 2:STE 102
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208
Mailing Address - Country:US
Mailing Address - Phone:206-227-9458
Mailing Address - Fax:
Practice Address - Street 1:1902 120TH PL NE
Practice Address - Street 2:STE 102
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:206-227-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60114777225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist