Provider Demographics
NPI:1760109771
Name:SCHMITZ, ALLYSON DEBRA
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:DEBRA
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34455 HAZELWOOD ST # A
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4487
Mailing Address - Country:US
Mailing Address - Phone:734-612-9886
Mailing Address - Fax:
Practice Address - Street 1:34455 HAZELWOOD ST # A
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-4487
Practice Address - Country:US
Practice Address - Phone:734-612-9886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
MI7501009029225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist