Healthcare Provider Details

I. General information

NPI: 1922902204
Provider Name (Legal Business Name): LONDA IRVIN LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 S MAIN ST
EATON RAPIDS MI
48827-1229
US

IV. Provider business mailing address

102 ALBERS ST
EATON RAPIDS MI
48827-1335
US

V. Phone/Fax

Practice location:
  • Phone: 517-256-5178
  • Fax:
Mailing address:
  • Phone: 517-256-5178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501014549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: