Provider Demographics
NPI:1710485891
Name:AXXIS MASSAGE, LLC
Entity Type:Organization
Organization Name:AXXIS MASSAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:734-773-2600
Mailing Address - Street 1:9864 E GRAND RIVER AVE
Mailing Address - Street 2:STE 110 BOX 191
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1999
Mailing Address - Country:US
Mailing Address - Phone:734-773-2600
Mailing Address - Fax:
Practice Address - Street 1:9864 E GRAND RIVER AVE
Practice Address - Street 2:STE 110 BOX 191
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1999
Practice Address - Country:US
Practice Address - Phone:734-773-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008986225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1073986477OtherNPI#