Healthcare Provider Details

I. General information

NPI: 1154285864
Provider Name (Legal Business Name): MICHELLE MORTIMER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4031 W PLANO PKWY STE 210
PLANO TX
75093-5619
US

IV. Provider business mailing address

3041 HAMILTON ST
PLANO TX
75075-1003
US

V. Phone/Fax

Practice location:
  • Phone: 214-728-2474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: