Provider Demographics
NPI:1780106377
Name:JONES, LAKEISHA (LMT)
Entity type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:
Last Name:JONES
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 1:8401 KARAM BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2175
Mailing Address - Country:US
Mailing Address - Phone:313-585-8817
Mailing Address - Fax:248-262-7804
Practice Address - Street 1:29540 SOUTHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2047
Practice Address - Country:US
Practice Address - Phone:248-212-1623
Practice Address - Fax:248-262-7804
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010338225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7501010338OtherSTATE OF MICHIGAN