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General NPI Number Information
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NPI Number | 1649077116
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Entity Type | Organization
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Legal Business Name | ACCIDENT RECOVERY THERAPEUTIC MASSAGE LLC
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Dates
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Enumeration Date | 03/03/2025
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 2900 PACKARD RD STE 1A
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City | YPSILANTI
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State | MI
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Zip | 48197-2061
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Country | US
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Telephone | 248-417-5352
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Fax | 888-793-5313
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Provider Business Mailing Address
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Address Line | 16500 JOY RD # 258
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City | DETROIT
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State | MI
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Zip | 48228-0632
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Country | US
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Telephone | 248-417-5352
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Fax | 888-793-5313
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Authorized Official
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Title or Position | OWNER
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Name | KELSEY LEE WALLACE JR.
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Credential | L.M.T.
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Telephone | 248-417-5352
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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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