Healthcare Provider Details

I. General information

NPI: 1972712800
Provider Name (Legal Business Name): PEGGY SUE DYER CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16801 NEWBURGH RD SUITE 114
LIVONIA MI
48154-1606
US

IV. Provider business mailing address

5000 TOWN CTR SUITE 2001
SOUTHFIELD MI
48075-1110
US

V. Phone/Fax

Practice location:
  • Phone: 248-910-3644
  • Fax:
Mailing address:
  • Phone: 586-685-0505
  • Fax: 586-685-0501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: