Provider Demographics
NPI:1649330960
Name:ROBERTS, MICHELLE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:ROBERTS
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 1:400 CHAMBERS ST
Mailing Address - Street 2:10Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1003
Mailing Address - Country:US
Mailing Address - Phone:917-304-2512
Mailing Address - Fax:212-213-5097
Practice Address - Street 1:18 E 41ST ST
Practice Address - Street 2:SUITE 1503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6222
Practice Address - Country:US
Practice Address - Phone:917-304-2512
Practice Address - Fax:212-213-5097
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009070225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist