MEDICARE: CAITIE THEISEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	7501015822	MI

General Provider Information

NPI Number	:	1316872070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITIE THEISEN

Provider Business Mailing Address
First Line	:	1112 E BROOMFIELD ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4437
Country	:	US
Telephone Number	:	989-779-2225
Fax Number	:	989-779-0106

Provider Business Practice Location Address
First Line	:	1112 E BROOMFIELD ST
Second Line	:
City	:	MT PLEASANT
State	:	MI
Zip	:	48858-4437
Country	:	US
Telephone Number	:	989-779-2225
Fax Number	:	989-779-0106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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Directions to “ CAITIE THEISEN ” Practice Location

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