Healthcare Provider Details

I. General information

NPI: 1124677596
Provider Name (Legal Business Name): BRIANNA BABIERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WATERSTRADT COMMERCE DR
DUNDEE MI
48131
US

IV. Provider business mailing address

226 SIDNEY ST
DUNDEE MI
48131-1267
US

V. Phone/Fax

Practice location:
  • Phone: 734-529-5138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501009170
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: