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General NPI Number Information
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NPI Number | 1023353554
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Entity Type | Organization
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Legal Business Name | RODERICK'S THERAPEUTIC MASSAGE SERVICE
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 14840 MAPLERIDGE ST
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City | DETROIT
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State | MI
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Zip | 48205-3023
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Country | US
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Telephone | 313-424-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 14840 MAPLERIDGE ST
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City | DETROIT
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State | MI
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Zip | 48205-3023
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Country | US
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Telephone | 313-424-2522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RODERICK DWAYNE WRIGHT
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Credential |
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Telephone | 313-424-2522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State | MI
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