Healthcare Provider Details

I. General information

NPI: 1427975903
Provider Name (Legal Business Name): SUMMER DENNISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2026
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 M 68 HWY STE D
INDIAN RIVER MI
49749-9366
US

IV. Provider business mailing address

13522 S STRAITS HWY
WOLVERINE MI
49799-9683
US

V. Phone/Fax

Practice location:
  • Phone: 231-268-1477
  • Fax:
Mailing address:
  • Phone: 248-910-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501016922
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: