Provider Demographics
NPI:1013604826
Name:REGO, MICHELLE DEGUZMAN (LMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DEGUZMAN
Last Name:REGO
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 1:1018 MILL RD
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-1314
Mailing Address - Country:US
Mailing Address - Phone:608-852-4221
Mailing Address - Fax:
Practice Address - Street 1:1452 GENESEE ST
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-1432
Practice Address - Country:US
Practice Address - Phone:262-646-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5014-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist