MEDICARE: MICHELLE HERRON LMT

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	2545	CA

General Provider Information

NPI Number	:	1073047262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HERRON LMT

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6930
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE STE 701
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6930
Country	:	US
Telephone Number	:	858-337-7801
Fax Number	:

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

Provider Enumeration Date	:	04/14/2017
Last Update Date	:	04/14/2017

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Directions to “ MICHELLE HERRON LMT” Practice Location

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