Provider Demographics
NPI:1669085809
Name:APGAR, MICHELE C (LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:APGAR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:C
Other - Last Name:APGAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:120 E GRANADA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-6630
Mailing Address - Country:US
Mailing Address - Phone:386-218-8367
Mailing Address - Fax:
Practice Address - Street 1:120 E GRANADA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-6630
Practice Address - Country:US
Practice Address - Phone:386-218-8367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79948225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty