Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501001810 | MI |
NPI | 1013360973 |
---|---|
Provider Name | Teresa Myers |
First Address | Ann Arbor, MI 48103-5018 |
Second Address | Ann Arbor, MI 48104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2016 |
Last Update Date | 15/07/2016 |