Individual
MELISSA WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
17439 FORT ST, RIVERVIEW, MI 48193-6630
(734) 365-7101
(734) 574-6006
Mailing address
17439 FORT ST, RIVERVIEW, MI 48193-6630
(734) 365-7101
(734) 574-6006
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501007455
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501007455
LICENSED MASSAGE THERAPIST
MI
Enumeration date
11/04/2020
Last updated
11/04/2020
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