Provider Demographics
NPI:1740582725
Name:HASEGAWA, V MICHELLE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:V
Middle Name:MICHELLE
Last Name:HASEGAWA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 W BELL RD STE H108
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8537
Mailing Address - Country:US
Mailing Address - Phone:602-571-4653
Mailing Address - Fax:
Practice Address - Street 1:7200 W BELL RD STE H108
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8537
Practice Address - Country:US
Practice Address - Phone:602-571-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-01091P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist