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NPI Code Detail

MEDICARE: MCKINLEY SIMS JR. MASSAGE THERAPIST

MEDICARE: MCKINLEY SIMS JR. MASSAGE THERAPIST
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist7501002379MI

General Provider Information

NPI Number : 1568889830
Entity Type Code : Individual
Provider Name (Legal Business Name) : MCKINLEY SIMS JR. MASSAGE THERAPIST
Provider Business Mailing Address
First Line : 2201 S. GETTY ST.
Second Line :
City : MUSKEGON HEIGHTS
State : MI
Zip : 49444
Country : US
Telephone Number : 231-737-1875
Fax Number :
Provider Business Practice Location Address
First Line : 2201 S GETTY ST
Second Line :
City : MUSKEGON HEIGHTS
State : MI
Zip : 49444-1207
Country : US
Telephone Number : 231-737-1875
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2014
Last Update Date : 03/25/2014

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