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General NPI Number Information
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NPI Number | 1366677288
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Entity Type | Individual
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Provider Name | MICHELLE MAE LEVELL LMT
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Gender | Female
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Dates
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Enumeration Date | 05/20/2009
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Last Update Date | 05/20/2009
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Provider Practice Location Address
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Address Line | 221 W ROOSEVELT AVE
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City | ELECTRA
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State | TX
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Zip | 76360-2437
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Country | US
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Telephone | 940-632-0558
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Fax |
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Provider Business Mailing Address
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Address Line | 105 AVENUE A
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City | ELECTRA
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State | TX
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Zip | 76360-1447
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Country | US
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Telephone | 940-632-0558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MT038536
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License Number State | TX
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