Healthcare Provider Details

I. General information

NPI: 1508229295
Provider Name (Legal Business Name): JOSHUA SKORUPSKI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25775 W 10 MILE RD SUITE C
SOUTHFIELD MI
48033-4856
US

IV. Provider business mailing address

25775 W 10 MILE RD SUITE C
SOUTHFIELD MI
48033-4856
US

V. Phone/Fax

Practice location:
  • Phone: 248-809-9941
  • Fax: 248-809-2480
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501008351
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: