Healthcare Provider Details

I. General information

NPI: 1841478617
Provider Name (Legal Business Name): ANN ARBOR THERAPEUTIC MASSAGE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 GOLFSIDE DR STE.4
ANN ARBOR MI
48108-1410
US

IV. Provider business mailing address

2900 GOLFSIDE DR STE.4
ANN ARBOR MI
48108-1410
US

V. Phone/Fax

Practice location:
  • Phone: 734-961-9227
  • Fax:
Mailing address:
  • Phone: 734-961-9227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS J. TRUDEAU
Title or Position: PRESIDENT
Credential: NCTMB
Phone: 734-961-9227