Provider Demographics
NPI:1174720965
Name:TALKINGTON, MISCHELLE ANNTOINETTE (LMT)
Entity type:Individual
Prefix:
First Name:MISCHELLE
Middle Name:ANNTOINETTE
Last Name:TALKINGTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MISCHELLE
Other - Middle Name:ANNTOINETTE
Other - Last Name:SHAFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:11311 TRALEE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-6450
Mailing Address - Country:US
Mailing Address - Phone:813-731-9242
Mailing Address - Fax:813-633-0881
Practice Address - Street 1:827 CYPRESS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-6838
Practice Address - Country:US
Practice Address - Phone:813-633-0669
Practice Address - Fax:813-633-0881
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA28258225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist