Provider Demographics
NPI:1679964290
Name:MARY ARNONE EPOCH HOLISTIC MASSAGE
Entity Type:Organization
Organization Name:MARY ARNONE EPOCH HOLISTIC MASSAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNONE
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:586-295-3034
Mailing Address - Street 1:22318 BENJAMIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2279
Mailing Address - Country:US
Mailing Address - Phone:586-295-3034
Mailing Address - Fax:
Practice Address - Street 1:28404 HARPER AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1607
Practice Address - Country:US
Practice Address - Phone:586-209-4432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003720261QH0100X, 261QP3300X, 261QR0401X
7501003720261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain