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General NPI Number Information
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NPI Number | 1467963066
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Entity Type | Organization
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Legal Business Name | PRO CARE MASSAGE CLINIC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 16000 W 9 MILE RD
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City | SOUTHFIELD
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State | MI
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Zip | 48075-4808
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Country | US
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Telephone | 313-704-3586
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Fax |
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Provider Business Mailing Address
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Address Line | 18336 AVON AVE
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City | DETROIT
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State | MI
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Zip | 48219-2954
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JERRY TUCKER
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Credential |
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Telephone | 313-704-3586
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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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