Provider Demographics
NPI:1972209955
Name:TAYLOR, MICHELLE LE (ACSM-CEP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:ACSM-CEP
Other - Prefix:
Other - First Name:MICHELE LE'
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACSM-CEP
Mailing Address - Street 1:29112 TOPEKA CIR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:92596-9627
Mailing Address - Country:US
Mailing Address - Phone:951-795-9482
Mailing Address - Fax:
Practice Address - Street 1:29112 TOPEKA CIR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:CA
Practice Address - Zip Code:92596-9627
Practice Address - Country:US
Practice Address - Phone:951-795-9482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1061453224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist