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General NPI Number Information
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NPI Number | 1407087299
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Entity Type | Organization
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Legal Business Name | CORPORATE MIND BODY SPA LLC
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 600 RENAISSANCE CTR # 1
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City | DETROIT
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State | MI
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Zip | 48243-1815
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Country | US
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Telephone | 313-393-7995
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Fax | 313-393-3208
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Provider Business Mailing Address
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Address Line | 600 RENAISSANCE CTR # 1
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City | DETROIT
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State | MI
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Zip | 48243-1815
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Country | US
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Telephone | 313-393-7995
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Fax | 313-393-3208
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LORESA ROBERTSON
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Credential |
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Telephone | 313-806-0962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State | MI
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