MEDICARE: MICHELLE THOMPSON L.AC, CMTPT

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	225700000X	Massage Therapist
2	171100000X	Acupuncturist	19510	CA

General Provider Information

NPI Number	:	1043947922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE THOMPSON L.AC, CMTPT

Provider Business Mailing Address
First Line	:	201 COGGINS DR APT B221
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-4572
Country	:	US
Telephone Number	:	860-280-6779
Fax Number	:

Provider Business Practice Location Address
First Line	:	870 MARKET ST STE 883
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-2910
Country	:	US
Telephone Number	:	415-362-6274
Fax Number	:

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

Provider Enumeration Date	:	08/02/2022
Last Update Date	:	08/02/2022

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