Provider Demographics
NPI:1477016764
Name:MICHIGAN MASSAGE THERAPY
Entity Type:Organization
Organization Name:MICHIGAN MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATMAZOHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-878-1091
Mailing Address - Street 1:23265 NORTHWESTERN HWY STE 100B
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-7707
Mailing Address - Country:US
Mailing Address - Phone:247-327-6755
Mailing Address - Fax:
Practice Address - Street 1:23265 NORTHWESTERN HWY STE 100B
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-7707
Practice Address - Country:US
Practice Address - Phone:248-327-6766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty