Provider Demographics
NPI:1720535586
Name:IKONEN-LOSKOWSKI, MATTHEW (LMT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:IKONEN-LOSKOWSKI
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35560 GRAND RIVER AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48335-3123
Mailing Address - Country:US
Mailing Address - Phone:734-276-3424
Mailing Address - Fax:
Practice Address - Street 1:35560 GRAND RIVER AVE STE 225
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-3123
Practice Address - Country:US
Practice Address - Phone:734-276-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008670225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist