Provider Demographics
NPI:1295102838
Name:PERRY, DENISE ANN (LICENSED MASSAGE THE)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:LICENSED MASSAGE THE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12298 WINDSOR BEACH DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9728
Mailing Address - Country:US
Mailing Address - Phone:810-240-3388
Mailing Address - Fax:
Practice Address - Street 1:12298 WINDSOR BEACH DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-9728
Practice Address - Country:US
Practice Address - Phone:810-240-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501002101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist