Provider Demographics
NPI:1518441302
Name:PRIAMI THERAPEUTIC MASSAGE, LLC
Entity Type:Organization
Organization Name:PRIAMI THERAPEUTIC MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:PRIAMI - GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-968-9585
Mailing Address - Street 1:18294 GILLMAN ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-3722
Mailing Address - Country:US
Mailing Address - Phone:734-968-9585
Mailing Address - Fax:
Practice Address - Street 1:37663 PEMBROKE AVE
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1050
Practice Address - Country:US
Practice Address - Phone:734-968-9585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty