Provider Demographics
NPI:1649457649
Name:GOYMERAC, MICHELLE LYNETTE (LMT)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNETTE
Last Name:GOYMERAC
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:DUMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80436-0391
Mailing Address - Country:US
Mailing Address - Phone:970-290-3545
Mailing Address - Fax:
Practice Address - Street 1:507 SILVER LAKES DR
Practice Address - Street 2:
Practice Address - City:DUMONT
Practice Address - State:CO
Practice Address - Zip Code:80436-5090
Practice Address - Country:US
Practice Address - Phone:970-290-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO664174400000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO352309556OtherMASSAGE THERAPY