Provider Demographics
NPI:1588209159
Name:COX, MICHELLE J (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:COX
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 1:105 CONCORD CIR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72076-3307
Mailing Address - Country:US
Mailing Address - Phone:605-251-7847
Mailing Address - Fax:
Practice Address - Street 1:12120 COLONEL GLENN RD STE 6200
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-2370
Practice Address - Country:US
Practice Address - Phone:501-313-2844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8380225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist