Provider Demographics
NPI:1003047127
Name:COMMUNITY THERAPY
Entity Type:Organization
Organization Name:COMMUNITY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:NCMT
Authorized Official - Phone:989-325-1526
Mailing Address - Street 1:519 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-1403
Mailing Address - Country:US
Mailing Address - Phone:989-325-1526
Mailing Address - Fax:
Practice Address - Street 1:519 PEARL ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1403
Practice Address - Country:US
Practice Address - Phone:989-325-1526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty