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NPI Code Detail

MEDICARE: TRANSCENDESSENCE, LLC

MEDICARE: TRANSCENDESSENCE, LLC
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
1225700000XMassage Therapist7501001358MI

General Provider Information

NPI Number : 1619469756
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRANSCENDESSENCE, LLC
Provider Business Mailing Address
First Line : 15510 BANNER ST
Second Line :
City : TAYLOR
State : MI
Zip : 48180-7703
Country : US
Telephone Number : 734-363-7522
Fax Number :
Provider Business Practice Location Address
First Line : 13330 FORT ST
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-1137
Country : US
Telephone Number : 734-309-6908
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DONNA FREEMAN RECTOR
Credential : LMT
Telephone Number : 734-363-7522
Provider Enumeration Date : 06/05/2018
Last Update Date : 06/05/2018

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Directions to “TRANSCENDESSENCE, LLC ” Practice Location

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