Provider Demographics
NPI:1487211322
Name:MICHIGAN MASSAGE AND WELLNESS
Entity Type:Organization
Organization Name:MICHIGAN MASSAGE AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMM
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:248-890-0172
Mailing Address - Street 1:330 E MAPLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2706
Mailing Address - Country:US
Mailing Address - Phone:248-795-5196
Mailing Address - Fax:
Practice Address - Street 1:330 E MAPLE RD STE H
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2706
Practice Address - Country:US
Practice Address - Phone:248-795-5196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty