Provider Demographics
NPI:1639423593
Name:FREYRE, MICHELLE (LMT, AOS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:FREYRE
Suffix:
Gender:F
Credentials:LMT, AOS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 VAN GORDON ST APT 12-251
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1520
Mailing Address - Country:US
Mailing Address - Phone:720-252-0747
Mailing Address - Fax:
Practice Address - Street 1:1520 SIMMS ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-2610
Practice Address - Country:US
Practice Address - Phone:720-252-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13237225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist