Provider Demographics
NPI:1649564303
Name:CADY-LEBO, MICHELLE TERESA (LMP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:TERESA
Last Name:CADY-LEBO
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 1:15217 N BONNETT ST
Mailing Address - Street 2:
Mailing Address - City:MEAD
Mailing Address - State:WA
Mailing Address - Zip Code:99021-9081
Mailing Address - Country:US
Mailing Address - Phone:509-220-8768
Mailing Address - Fax:
Practice Address - Street 1:3810 N MONROE ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2852
Practice Address - Country:US
Practice Address - Phone:509-327-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-30
Last Update Date:2011-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60118664225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist