Provider Demographics
NPI:1114634003
Name:DEAN, MONIZUE (LMT)
Entity Type:Individual
Prefix:
First Name:MONIZUE
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:STANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26129 GRAND RIVER AVE # 1077
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48240-1442
Mailing Address - Country:US
Mailing Address - Phone:734-215-7421
Mailing Address - Fax:
Practice Address - Street 1:29610 SOUTHFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2000
Practice Address - Country:US
Practice Address - Phone:734-215-7421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008117225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty