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General NPI Number Information
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NPI Number | 1194665992
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MICHIGAN INTEGRATIVE MASSAGE CENTER, PLLC
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 2907 DIVISION ST STE 112
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2472
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Country | US
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Telephone | 269-369-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 2907 DIVISION ST STE 112
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City | SAINT JOSEPH
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State | MI
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Zip | 49085-2472
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Country | US
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Telephone | 269-369-7010
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | TINA WENONA LATHAM-ENIX
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Credential | LMT
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Telephone | 269-369-7010
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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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