=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851114748
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THERAPEUTIC HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 360 CANTLEY ST
-----------------------------------------------------
City | LEONARD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48367-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-798-9386
-----------------------------------------------------
Fax | 248-605-0300
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 360 CANTLEY ST
-----------------------------------------------------
City | LEONARD
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48367-6602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 248-798-9386
-----------------------------------------------------
Fax | 248-605-0300
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DUANE L TRAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 248-798-9386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------