Individual
MICHELLE MARIE LICAVOLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20045 N 19TH AVE STE 166, PHOENIX, AZ 85027-4254
(480) 253-6196
Mailing address
19442 N 7TH DR, PHOENIX, AZ 85027-4682
(480) 253-6196
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT-16994
AZ
Other
Enumeration date
02/05/2025
Last updated
02/05/2025
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