Provider Demographics
NPI:1710906029
Name:THOMPSON, MICHELLE E (MT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:E
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-7469
Mailing Address - Country:US
Mailing Address - Phone:561-967-8888
Mailing Address - Fax:561-641-8303
Practice Address - Street 1:4623 FOREST HILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-7469
Practice Address - Country:US
Practice Address - Phone:561-967-8888
Practice Address - Fax:561-641-8303
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA32966171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA32966OtherMASSAGE THERAPIST LICENSE