Provider Demographics
NPI:1598154924
Name:METROFF, REBECCA SUE (LMT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUE
Last Name:METROFF
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 1:107 OLDS ST STE 7
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49250-1188
Mailing Address - Country:US
Mailing Address - Phone:517-849-9002
Mailing Address - Fax:517-849-9063
Practice Address - Street 1:107 OLDS ST STE 7
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:MI
Practice Address - Zip Code:49250-1188
Practice Address - Country:US
Practice Address - Phone:517-849-9002
Practice Address - Fax:517-849-9063
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001924174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist