Provider Demographics
NPI:1356512461
Name:PROFESSIONAL MASSAGE THERAPY WERKS, INC
Entity type:Organization
Organization Name:PROFESSIONAL MASSAGE THERAPY WERKS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GERBER
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB
Authorized Official - Phone:734-854-2441
Mailing Address - Street 1:3395 W TEMPERANCE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9706
Mailing Address - Country:US
Mailing Address - Phone:734-854-2441
Mailing Address - Fax:734-854-2441
Practice Address - Street 1:8336 MONROE RD
Practice Address - Street 2:OLDE SCHOOLHOUSE COMMONS ROOM 103
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9339
Practice Address - Country:US
Practice Address - Phone:734-854-2441
Practice Address - Fax:734-854-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty