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General NPI Number Information
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NPI Number | 1619469756
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Entity Type | Organization
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Legal Business Name | TRANSCENDESSENCE, LLC
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 13330 FORT ST
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City | SOUTHGATE
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State | MI
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Zip | 48195-1137
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Country | US
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Telephone | 734-309-6908
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Fax |
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Provider Business Mailing Address
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Address Line | 15510 BANNER ST
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City | TAYLOR
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State | MI
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Zip | 48180-7703
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Country | US
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Telephone | 734-363-7522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DONNA FREEMAN RECTOR
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Credential | LMT
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Telephone | 734-363-7522
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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 | 7501001358
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License Number State | MI
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