Provider Demographics
NPI:1386179539
Name:NASH, LISAMARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LISAMARIE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43000 W 9 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-4175
Mailing Address - Country:US
Mailing Address - Phone:248-747-0268
Mailing Address - Fax:
Practice Address - Street 1:43000 W 9 MILE RD
Practice Address - Street 2:217
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-4175
Practice Address - Country:US
Practice Address - Phone:248-747-0268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501000847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist