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General NPI Number Information
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NPI Number | 1326506742
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Entity Type | Organization
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Legal Business Name | 640RX PLC
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 09/21/2019
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Provider Practice Location Address
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Address Line | 400 N 3RD AVE
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City | FRUITPORT
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State | MI
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Zip | 49415-9774
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Country | US
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Telephone | 231-747-9163
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Fax |
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Provider Business Mailing Address
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Address Line | 400 N 3RD AVE
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City | FRUITPORT
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State | MI
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Zip | 49415-9774
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Country | US
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Telephone | 231-747-9163
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | JODY LYNN GREGG-DUCHEMIN
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Credential | LMT
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Telephone | 231-747-9163
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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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Taxonomy #2
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number |
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License Number State |
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