Healthcare Provider Details

I. General information

NPI: 1649116724
Provider Name (Legal Business Name): EARTHENWELL THERAPEUTIC MASSAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 W FRONT ST STE 150A
TRAVERSE CITY MI
49684-2265
US

IV. Provider business mailing address

440 W FRONT ST STE 150A
TRAVERSE CITY MI
49684-2265
US

V. Phone/Fax

Practice location:
  • Phone: 231-342-8839
  • Fax:
Mailing address:
  • Phone: 231-342-8839
  • 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: EMMA STARPOLI
Title or Position: OWNER/MASSAGE THERAPIST
Credential:
Phone: 231-342-8839