Healthcare Provider Details

I. General information

NPI: 1649330960
Provider Name (Legal Business Name): MICHELLE ROBERTS L.M.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 E 41ST ST SUITE 1503
NEW YORK NY
10017-6222
US

IV. Provider business mailing address

400 CHAMBERS ST 10Y
NEW YORK NY
10282-1003
US

V. Phone/Fax

Practice location:
  • Phone: 917-304-2512
  • Fax: 212-213-5097
Mailing address:
  • Phone: 917-304-2512
  • Fax: 212-213-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number009070
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: