MEDICARE: MRS. MICHELLE ELISE LEMAY-HUMBLE PTA

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	225200000X	Physical Therapy Assistant	AT 1767	CA

General Provider Information

NPI Number	:	1396949731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ELISE LEMAY-HUMBLE PTA

Provider Business Mailing Address
First Line	:	14321 S C AND D BLVD
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-9147
Country	:	US
Telephone Number	:	760-921-2133
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 N 1ST ST STE E
Second Line	:
City	:	BLYTHE
State	:	CA
Zip	:	92225-1777
Country	:	US
Telephone Number	:	760-921-3722
Fax Number	:

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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