Provider Demographics
NPI:1265838536
Name:NEUNER, MICHELLE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:NEUNER
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 1:75 SOCKANOSSET CROSS RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-5558
Mailing Address - Country:US
Mailing Address - Phone:401-225-2021
Mailing Address - Fax:
Practice Address - Street 1:75 SOCKANOSSET CROSS RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5558
Practice Address - Country:US
Practice Address - Phone:401-225-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI582225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist