Provider Demographics
NPI:1982456364
Name:DE DMON, MICHELLE JULIA (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JULIA
Last Name:DE DMON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W HORIZON RIDGE PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4840
Mailing Address - Country:US
Mailing Address - Phone:702-779-0147
Mailing Address - Fax:
Practice Address - Street 1:6031 W CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-4200
Practice Address - Country:US
Practice Address - Phone:702-658-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6309225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist