Provider Demographics
NPI:1144416520
Name:REAR, MICHELLE MARIE (LMT)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:REAR
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 1:1369 NE SHARKEY TER
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6040
Mailing Address - Country:US
Mailing Address - Phone:541-977-3300
Mailing Address - Fax:
Practice Address - Street 1:731 NW FRANKLIN AVE
Practice Address - Street 2:SUITE 100/100A
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-2752
Practice Address - Country:US
Practice Address - Phone:541-598-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11583225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist