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General NPI Number Information
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NPI Number | 1689126468
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Entity Type | Organization
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Legal Business Name | VERDUROUS ME, LLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 49881 GRAND RIVER AVE
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City | WIXOM
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State | MI
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Zip | 48393-3309
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Country | US
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Telephone | 248-229-4016
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Fax |
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Provider Business Mailing Address
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Address Line | 49881 GRAND RIVER AVE
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City | WIXOM
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State | MI
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Zip | 48393-3309
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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 | WELLNESS SPECIALIST
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Name | LEESA HANSKNECHT
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Credential |
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Telephone | 248-229-4016
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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 | 7501008527
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License Number State | MI
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