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General NPI Number Information
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NPI Number | 1902291198
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Entity Type | Organization
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Legal Business Name | MICHIGAN IMASSAGE
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 140 W RIVER ST SUITE 10
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City | CADILLAC
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State | MI
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Zip | 49601-1862
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Country | US
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Telephone | 231-853-3818
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Fax |
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Provider Business Mailing Address
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Address Line | 140 W RIVER ST SUITE 10
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City | CADILLAC
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State | MI
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Zip | 49601-1862
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Country | US
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Telephone | 231-853-3818
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. BECKY LYNN STIMAK
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Credential | LMT
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Telephone | 231-853-3818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 7501000195
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License Number State | MI
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