Provider Demographics
NPI:1093074668
Name:PREMIER MEDICAL MASSAGE
Entity Type:Organization
Organization Name:PREMIER MEDICAL MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KOEHLER
Authorized Official - Suffix:
Authorized Official - Credentials:CMT, NCMTB
Authorized Official - Phone:248-636-0681
Mailing Address - Street 1:PO BOX 250005
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:MI
Mailing Address - Zip Code:48025-0005
Mailing Address - Country:US
Mailing Address - Phone:248-636-0681
Mailing Address - Fax:
Practice Address - Street 1:21777 POINCIANA ST
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5049
Practice Address - Country:US
Practice Address - Phone:248-636-0681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty