Provider Demographics
NPI:1326207689
Name:SPANN, MICHELE LYNN (LMT)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:LYNN
Last Name:SPANN
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 1:12565 N AVENIDA SATURNO
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-9436
Mailing Address - Country:US
Mailing Address - Phone:623-523-2016
Mailing Address - Fax:
Practice Address - Street 1:12565 N AVENIDA SATURNO
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-9436
Practice Address - Country:US
Practice Address - Phone:623-523-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-20311225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist