MEDICARE: RENEW THERAPEUTIC MASSAGE LLC

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
1	225700000X	Massage Therapist		MI

General Provider Information

NPI Number	:	1932526506
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW THERAPEUTIC MASSAGE LLC

Provider Business Mailing Address
First Line	:	35560 GRAND RIVER AVE
Second Line	:	SUITE 225
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-3123
Country	:	US
Telephone Number	:	734-276-3424
Fax Number	:	734-236-4426

Provider Business Practice Location Address
First Line	:	35560 GRAND RIVER AVE
Second Line	:	SUITE 225
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48335-3123
Country	:	US
Telephone Number	:	734-276-3424
Fax Number	:	734-236-4426

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NATALIE CATT
Credential	:
Telephone Number	:	734-276-3424

Provider Enumeration Date	:	03/21/2014
Last Update Date	:	03/21/2014

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