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General NPI Number Information
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NPI Number | 1811265549
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MASSAGE, LLC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1342 S HILLSDALE RD
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City | HILLSDALE
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State | MI
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Zip | 49242-9367
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Country | US
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Telephone | 517-439-4263
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Fax | 517-439-4263
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Provider Business Mailing Address
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Address Line | 1342 S HILLSDALE RD
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City | HILLSDALE
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State | MI
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Zip | 49242-9367
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Country | US
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Telephone | 517-439-4263
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Fax | 517-439-4263
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Authorized Official
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Title or Position | OWNER/MASSAGE THERAPIST
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Name | TREESA MOREEN WEAVER-RICH
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Credential | N.C.T.M.B.
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Telephone | 517-439-4263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 196655-00
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License Number State | MI
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