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General NPI Number Information
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NPI Number | 1477016764
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Entity Type | Organization
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Legal Business Name | MICHIGAN MASSAGE THERAPY
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Dates
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Enumeration Date | 04/12/2019
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Last Update Date | 04/12/2019
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Provider Practice Location Address
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Address Line | 23265 NORTHWESTERN HWY STE 100B
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7707
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Country | US
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Telephone | 248-327-6766
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Fax |
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Provider Business Mailing Address
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Address Line | 23265 NORTHWESTERN HWY STE 100B
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City | SOUTHFIELD
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State | MI
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Zip | 48075-7707
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Country | US
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Telephone | 247-327-6755
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FATMAZOHRA LAKHAL
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Credential |
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Telephone | 313-878-1091
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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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