Provider Demographics
NPI:1073986477
Name:CIERPIAL, MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CIERPIAL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 DUCK LN
Mailing Address - Street 2:
Mailing Address - City:WALLED LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48390-3043
Mailing Address - Country:US
Mailing Address - Phone:734-945-0152
Mailing Address - Fax:
Practice Address - Street 1:35560 GRAND RIVER AVE
Practice Address - Street 2:STE. 225
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3123
Practice Address - Country:US
Practice Address - Phone:734-276-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist