Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003147992 |
---|---|
Provider Name | Angela C Brewer |
First Address | Southfield, MI 48075-1110 |
Second Address | Livonia, MI 48154-1606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2010 |
Last Update Date | 18/01/2010 |