Healthcare Provider Details

I. General information

NPI: 1043123722
Provider Name (Legal Business Name): MICHELLE LYDIA MUELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 W BLUEMOUND RD STE 125
WAUWATOSA WI
53213-3367
US

IV. Provider business mailing address

8320 W BLUEMOUND RD STE 125
WAUWATOSA WI
53213-3367
US

V. Phone/Fax

Practice location:
  • Phone: 414-302-3800
  • Fax:
Mailing address:
  • Phone: 414-302-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2365-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: