Provider Demographics
NPI:1780345645
Name:DUVALL, AMBER RENE (LMT)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:RENE
Last Name:DUVALL
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 1:530602 PEMBROOKE AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48153
Mailing Address - Country:US
Mailing Address - Phone:734-748-4217
Mailing Address - Fax:
Practice Address - Street 1:712 CASS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48226-3114
Practice Address - Country:US
Practice Address - Phone:313-338-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010122225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist