Healthcare Provider Details

I. General information

NPI: 1093656324
Provider Name (Legal Business Name): RICHARD BOOKER LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31904 RYAN RD
WARREN MI
48092-1339
US

IV. Provider business mailing address

24634 MARINE AVE
EASTPOINTE MI
48021-1477
US

V. Phone/Fax

Practice location:
  • Phone: 586-344-4458
  • Fax: 586-314-0574
Mailing address:
  • Phone: 248-949-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number7501017413
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: