Provider Demographics
NPI:1356064885
Name:NUNEZ, MICHELLE LYNETTE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNETTE
Last Name:NUNEZ
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 1:3312 VINEYARD TRL
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8847
Mailing Address - Country:US
Mailing Address - Phone:334-494-0923
Mailing Address - Fax:
Practice Address - Street 1:3800 S W S YOUNG DR STE 104D
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-3312
Practice Address - Country:US
Practice Address - Phone:334-494-0923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123951225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty