Healthcare Provider Details

I. General information

NPI: 1003298498
Provider Name (Legal Business Name): ALESHA KAY FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3337 W SOUTH AIRPORT RD SUITE 3
TRAVERSE CITY MI
49684
US

IV. Provider business mailing address

125 E SLEIGHTS RD
TRAVERSE CITY MI
49696-8355
US

V. Phone/Fax

Practice location:
  • Phone: 231-922-8100
  • Fax:
Mailing address:
  • Phone: 231-360-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501008019
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: