Provider Demographics
NPI:1396985743
Name:ZANGA, MICHELLE J (LCMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:ZANGA
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-0623
Mailing Address - Country:US
Mailing Address - Phone:970-275-4870
Mailing Address - Fax:
Practice Address - Street 1:123 W TOMICHI AVE
Practice Address - Street 2:# 7
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2345
Practice Address - Country:US
Practice Address - Phone:970-275-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1364172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist