Provider Demographics
NPI:1629547054
Name:HEALY, NICHOLAS DONALD (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DONALD
Last Name:HEALY
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 LALONDE CT
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2425
Mailing Address - Country:US
Mailing Address - Phone:248-495-7762
Mailing Address - Fax:
Practice Address - Street 1:494 LALONDE CT
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2425
Practice Address - Country:US
Practice Address - Phone:248-495-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010760225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist