Provider Demographics
NPI:1922757392
Name:CHILDS, MICHELE MONET (LMT)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:MONET
Last Name:CHILDS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1710
Mailing Address - Country:US
Mailing Address - Phone:267-450-9707
Mailing Address - Fax:
Practice Address - Street 1:116 E BROAD ST STE 203
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1710
Practice Address - Country:US
Practice Address - Phone:267-450-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001810225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist