Individual
FAWNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
44191 PLYMOUTH OAKS BLVD, SUITE 400, PLYMOUTH, MI 48170-6530
(734) 259-7103
Mailing address
44191 PLYMOUTH OAKS BLVD, SUITE 400, PLYMOUTH, MI 48170-6530
(734) 259-7103
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501002781
MI
Other
Enumeration date
11/16/2015
Last updated
11/16/2015
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