Provider Demographics
NPI:1235856378
Name:LETOURNEAU, CHRISTINE (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:LETOURNEAU
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12508 APPLE LN
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48065-3803
Mailing Address - Country:US
Mailing Address - Phone:586-997-7753
Mailing Address - Fax:
Practice Address - Street 1:122 S RAWLES ST STE 122
Practice Address - Street 2:
Practice Address - City:ROMEO
Practice Address - State:MI
Practice Address - Zip Code:48065-5606
Practice Address - Country:US
Practice Address - Phone:586-997-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501011041225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty