Provider Demographics
NPI:1851570915
Name:ROSS ROCKWELL, MICHELE A (LMT)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:ROSS ROCKWELL
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 1:961 NW BROOKS ST # 2
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2170
Mailing Address - Country:US
Mailing Address - Phone:541-388-4417
Mailing Address - Fax:
Practice Address - Street 1:961 NW BROOKS ST # 2
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2170
Practice Address - Country:US
Practice Address - Phone:541-388-4417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR909225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR909OtherSTATE LMT LICENSE #