Healthcare Provider Details

I. General information

NPI: 1265369516
Provider Name (Legal Business Name): ANDREA LIPSCOMB LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W MICHIGAN AVE
THREE RIVERS MI
49093-3110
US

IV. Provider business mailing address

14340 BURLEW ROAD
THREE RIVERS MI
49093
US

V. Phone/Fax

Practice location:
  • Phone: 269-680-7911
  • Fax:
Mailing address:
  • Phone: 269-680-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: