=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720944150
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA ANNE VELCHANSKY CMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2025
-----------------------------------------------------
Last Update Date | 12/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1424 N MCEWAN ST
-----------------------------------------------------
City | CLARE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48617-1114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-3838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7828 FINLEY LAKE AVE
-----------------------------------------------------
City | FARWELL
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48622-9727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 989-386-3838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | 7501006558
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------