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General NPI Number Information
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NPI Number | 1053172478
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Entity Type | Organization
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Legal Business Name | THE BLUE HOUSE COMPANY LLC
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Dates
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Enumeration Date | 01/22/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 35418 JEFFERSON AVE
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City | HARRISON TOWNSHIP
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State | MI
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Zip | 48045-3247
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Country | US
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Telephone | 586-665-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 14040 NORMAN RD
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City | LYNN
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State | MI
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Zip | 48097-1801
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Country | US
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Telephone | 586-557-6752
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA STARR
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Credential | LMT
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Telephone | 586-557-6752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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