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General NPI Number Information
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NPI Number | 1992316871
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Entity Type | Organization
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Legal Business Name | REFLEX MANUAL THERAPY LLC
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Dates
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Enumeration Date | 08/13/2020
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Last Update Date | 08/13/2020
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Provider Practice Location Address
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Address Line | 22681 MORELLI DR
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City | CLINTON TOWNSHIP
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State | MI
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Zip | 48036-1152
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Country | US
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Telephone | 586-221-0138
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Fax |
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Provider Business Mailing Address
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Address Line | 247 WELLINGTON CRES
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2946
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Country | US
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Telephone | 586-221-0138
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALLAN T MOLTMAKER
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Credential | LMT
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Telephone | 586-221-0138
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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 |
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License Number State |
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