Provider Demographics
NPI:1821674177
Name:REYNOLDS, MICHELLE INA (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:INA
Last Name:REYNOLDS
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 1:5 HICKORY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2419
Mailing Address - Country:US
Mailing Address - Phone:406-581-4400
Mailing Address - Fax:
Practice Address - Street 1:5 HICKORY RIDGE CT
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2419
Practice Address - Country:US
Practice Address - Phone:406-581-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM06208225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist