Most Relevant Information
Provider Data
| NPI Number: | 1003429408 |
| Provider Name: | MICHELLE BOLLER CMT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | 29634 |
Most Important Dates
| Enumeration Date: | 08/25/2020 |
| Last Updated: | 08/25/2020 |
Provider Practice Location
813 W WASHINGTON ST
SAN DIEGO
CA
921031804
Practice Location Phone/Fax
| Phone: | 6192699909 |
| Fax: |
Provider Mailing Location
3009 UNION ST UNIT 2
SAN DIEGO
CA
921036080
Provider Mailing Phone/Fax
| Phone: | 9177101325 |
| Fax: |