Provider Demographics
NPI:1417553140
Name:ADUFUTSE, MIANNE AFUA (LMT)
Entity Type:Individual
Prefix:MS
First Name:MIANNE
Middle Name:AFUA
Last Name:ADUFUTSE
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 1:43241 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1812
Mailing Address - Country:US
Mailing Address - Phone:305-924-0303
Mailing Address - Fax:
Practice Address - Street 1:43241 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1812
Practice Address - Country:US
Practice Address - Phone:305-924-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2023-03-09
Deactivation Date:2021-02-25
Deactivation Code:
Reactivation Date:2023-03-09
Provider Licenses
StateLicense IDTaxonomies
MI7501005970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist