Provider Demographics
NPI:1710654769
Name:MASTEROV, SERGEY (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:SERGEY
Middle Name:
Last Name:MASTEROV
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 1:28300 FRANKLIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1657
Mailing Address - Country:US
Mailing Address - Phone:248-354-8180
Mailing Address - Fax:248-354-8199
Practice Address - Street 1:28300 FRANKLIN RD STE A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1657
Practice Address - Country:US
Practice Address - Phone:248-354-8180
Practice Address - Fax:248-354-8199
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003883225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty