MEDICARE: MICHELLE JULIA DE DMON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6309	NV

General Provider Information

NPI Number	:	1982456364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE JULIA DE DMON DPT

Provider Business Mailing Address
First Line	:	1700 W HORIZON RIDGE PKWY STE 204
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-4840
Country	:	US
Telephone Number	:	702-779-0147
Fax Number	:

Provider Business Practice Location Address
First Line	:	6031 W CHEYENNE AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-4200
Country	:	US
Telephone Number	:	702-658-5882
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2024
Last Update Date	:	05/29/2025

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