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General NPI Number Information
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NPI Number | 1710485891
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Entity Type | Organization
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Legal Business Name | AXXIS MASSAGE, LLC
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Dates
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Enumeration Date | 01/24/2018
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Last Update Date | 01/24/2018
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Provider Practice Location Address
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Address Line | 9864 E GRAND RIVER AVE STE 110 BOX 191
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City | BRIGHTON
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State | MI
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Zip | 48116-1999
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Country | US
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Telephone | 734-773-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 9864 E GRAND RIVER AVE STE 110 BOX 191
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City | BRIGHTON
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State | MI
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Zip | 48116-1999
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Country | US
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Telephone | 734-773-2600
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIE RAYMOND
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Credential | LMT
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Telephone | 734-773-2600
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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 | 7501008986
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License Number State | MI
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