Provider Demographics
NPI:1699900506
Name:SMITH, MICHELLE M (LMT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:SMITH
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 1:6291 W ELMHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-5924
Mailing Address - Country:US
Mailing Address - Phone:720-563-1251
Mailing Address - Fax:
Practice Address - Street 1:6291 W ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-5924
Practice Address - Country:US
Practice Address - Phone:720-563-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-00416P225700000X
CO6339225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist