Healthcare Provider Details

I. General information

NPI: 1316872070
Provider Name (Legal Business Name): CAITIE THEISEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E BROOMFIELD ST
MT PLEASANT MI
48858-4437
US

IV. Provider business mailing address

1112 E BROOMFIELD ST
MT PLEASANT MI
48858-4437
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-2225
  • Fax: 989-779-0106
Mailing address:
  • Phone: 989-779-2225
  • Fax: 989-779-0106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501015822
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: