Provider Demographics
NPI:1770712978
Name:SPACKMAN, MICHAEL LEE (NMT, CMT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:SPACKMAN
Suffix:
Gender:M
Credentials:NMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 O ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6542
Mailing Address - Country:US
Mailing Address - Phone:916-281-4284
Mailing Address - Fax:
Practice Address - Street 1:3112 O ST
Practice Address - Street 2:SUITE #1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6542
Practice Address - Country:US
Practice Address - Phone:916-281-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist