Provider Demographics
NPI:1134597552
Name:DREESE, DUSTIN PALMER (LMT)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:PALMER
Last Name:DREESE
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 1:26789 WOODWARD AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1334
Mailing Address - Country:US
Mailing Address - Phone:248-631-4728
Mailing Address - Fax:
Practice Address - Street 1:26789 WOODWARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1334
Practice Address - Country:US
Practice Address - Phone:248-631-4728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008282225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist