Provider Demographics
NPI:1376998617
Name:MOLTMAKER, ALLAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALLAN
Middle Name:
Last Name:MOLTMAKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 WELLINGTON CRES
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2946
Mailing Address - Country:US
Mailing Address - Phone:586-221-0138
Mailing Address - Fax:707-220-4729
Practice Address - Street 1:22681 MORELLI DR
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-1152
Practice Address - Country:US
Practice Address - Phone:586-221-0138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist