Provider Demographics
NPI:1710336995
Name:MASSAGE MATTERS MICHIGAN LLC
Entity Type:Organization
Organization Name:MASSAGE MATTERS MICHIGAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MASSAGE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERITTA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:313-293-1054
Mailing Address - Street 1:13960 METTETAL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48227-1747
Mailing Address - Country:US
Mailing Address - Phone:313-586-2026
Mailing Address - Fax:866-466-3087
Practice Address - Street 1:21331 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3265
Practice Address - Country:US
Practice Address - Phone:313-293-9427
Practice Address - Fax:866-466-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501009330251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare