Provider Demographics
NPI:1841478617
Name:ANN ARBOR THERAPEUTIC MASSAGE CLINIC
Entity type:Organization
Organization Name:ANN ARBOR THERAPEUTIC MASSAGE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRUDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:NCTMB
Authorized Official - Phone:734-961-9227
Mailing Address - Street 1:2900 GOLFSIDE DR
Mailing Address - Street 2:STE.4
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1410
Mailing Address - Country:US
Mailing Address - Phone:734-961-9227
Mailing Address - Fax:
Practice Address - Street 1:2900 GOLFSIDE DR
Practice Address - Street 2:STE.4
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1410
Practice Address - Country:US
Practice Address - Phone:734-961-9227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty