Provider Demographics
NPI:1497303390
Name:PRIER, GERALD EDWARDS (LMT)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:EDWARDS
Last Name:PRIER
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 1:609 EMMET ST
Mailing Address - Street 2:4
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-5053
Mailing Address - Country:US
Mailing Address - Phone:734-945-9939
Mailing Address - Fax:
Practice Address - Street 1:609 EMMET ST
Practice Address - Street 2:4
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-5053
Practice Address - Country:US
Practice Address - Phone:734-945-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008553225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501008553OtherMASSAGE THERAPY LICENSE