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General NPI Number Information
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NPI Number | 1215406426
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Entity Type | Individual
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Provider Name | AMELIA LIPOVSKY LMT, CPT
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Gender | Female
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Dates
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Enumeration Date | 11/16/2018
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 28351 BECK RD STE G3
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City | WIXOM
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State | MI
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Zip | 48393-4752
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Country | US
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Telephone | 248-770-1875
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Fax |
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Provider Business Mailing Address
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Address Line | 981 ROUND LAKE RD
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City | WHITE LAKE
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State | MI
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Zip | 48386-3262
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Country | US
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Telephone | 248-770-1875
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 7501003674
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License Number State | MI
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