Provider Demographics
NPI:1386936987
Name:CLENDINEN, MICHEL ROSADIA (LMT)
Entity type:Individual
Prefix:MRS
First Name:MICHEL
Middle Name:ROSADIA
Last Name:CLENDINEN
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 1:4829 LIGHTHOUSE CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1226
Mailing Address - Country:US
Mailing Address - Phone:407-371-1278
Mailing Address - Fax:407-601-6154
Practice Address - Street 1:4829 LIGHTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1226
Practice Address - Country:US
Practice Address - Phone:407-371-1278
Practice Address - Fax:407-601-6154
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-15
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60674225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist