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General NPI Number Information
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NPI Number | 1659771947
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Entity Type | Organization
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Legal Business Name | ORION THERAPEUTIC MASSAGE
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Dates
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Enumeration Date | 08/25/2014
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Last Update Date | 08/25/2014
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Provider Practice Location Address
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Address Line | 1239 ALPINE AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-3170
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Country | US
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Telephone | 616-459-7664
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Fax |
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Provider Business Mailing Address
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Address Line | 1239 ALPINE AVE NW
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City | GRAND RAPIDS
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State | MI
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Zip | 49504-3170
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Country | US
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Telephone | 616-459-7664
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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 | MR. ADAM PHILLIP SMITH
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Credential | L.M.T.
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Telephone | 616-459-7664
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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 | 7501003962
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License Number State | MI
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