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General NPI Number Information
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NPI Number | 1437549599
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Entity Type | Organization
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Legal Business Name | BRIGHTON MASSAGE WORKS, INC
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 01/28/2015
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Provider Practice Location Address
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Address Line | 2209 EULER RD SUITE 3
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City | BRIGHTON
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State | MI
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Zip | 48114-6815
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Country | US
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Telephone | 810-225-4726
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Fax |
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Provider Business Mailing Address
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Address Line | 1561 REYNOLDS DR
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City | BRIGHTON
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State | MI
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Zip | 48114-8787
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Country | US
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Telephone | 810-844-2131
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | MARIA THERESE CAMPBELL
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Credential | LMT
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Telephone | 810-225-4726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 7501004003
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License Number State | MI
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