Healthcare Provider Details

I. General information

NPI: 1952942419
Provider Name (Legal Business Name): DIONNE STEWART LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13719 23 MILE RD # 170
SHELBY TOWNSHIP MI
48315-2907
US

IV. Provider business mailing address

PO BOX 131011
DETROIT MI
48213-8111
US

V. Phone/Fax

Practice location:
  • Phone: 313-550-0793
  • Fax:
Mailing address:
  • Phone: 313-550-0793
  • Fax:

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: