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General NPI Number Information
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NPI Number | 1689937328
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Entity Type | Organization
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Legal Business Name | ESSENTIAL MASSAGE THERAPY
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 22941 WOODWARD AVE
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City | FERNDALE
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State | MI
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Zip | 48220-1739
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Country | US
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Telephone | 248-547-5428
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Fax | 248-547-7630
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Provider Business Mailing Address
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Address Line | 22941 WOODWARD AVE
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City | FERNDALE
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State | MI
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Zip | 48220-1739
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Country | US
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Telephone | 248-547-5428
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Fax | 248-547-7630
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LISA BOYD
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Credential |
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Telephone | 248-547-5428
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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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