Provider Demographics
NPI:1154599017
Name:MEULENDYK, MICHELE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MEULENDYK
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:PO BOX 6393
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05302-6393
Mailing Address - Country:US
Mailing Address - Phone:907-491-0505
Mailing Address - Fax:
Practice Address - Street 1:120 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6101
Practice Address - Country:US
Practice Address - Phone:907-491-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11050172M00000X
VT164.0000684172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist