Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | M196760 | MI |
NPI | 1003365230 |
---|---|
Provider Name | James Saltalamacchia |
First Address | Monroe, MI 48161-4726 |
Second Address | Farmington Hills, MI 48335-3123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2016 |
Last Update Date | 29/09/2016 |