Provider Demographics
NPI:1225155054
Name:REED, MARK (NCTMB)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:REED
Suffix:
Gender:M
Credentials:NCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-2211
Mailing Address - Country:US
Mailing Address - Phone:734-671-4987
Mailing Address - Fax:
Practice Address - Street 1:3133 VAN HORN RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-4070
Practice Address - Country:US
Practice Address - Phone:734-671-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist