Provider Demographics
NPI:1790146850
Name:GOLAB, REANNA (LMT)
Entity Type:Individual
Prefix:
First Name:REANNA
Middle Name:
Last Name:GOLAB
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52152 HEATHERSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3553
Mailing Address - Country:US
Mailing Address - Phone:586-531-6860
Mailing Address - Fax:
Practice Address - Street 1:51064 FILOMENA DR
Practice Address - Street 2:
Practice Address - City:SHELBY TWP
Practice Address - State:MI
Practice Address - Zip Code:48315-2937
Practice Address - Country:US
Practice Address - Phone:586-531-6860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist