Individual
RENISE MICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
9219 INDIANAPOLIS BLVD STE 204, HIGHLAND, IN 46322-2573
(219) 501-6575
Mailing address
7550 COLUMBIA AVE APT 5, HAMMOND, IN 46324-3059
(219) 501-6575
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT21806622
IN
Other
Enumeration date
02/07/2023
Last updated
02/07/2023
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