Individual
MATEEN THRELKELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
1265 W HURON ST STE 101, WATERFORD, MI 48328-3677
(248) 977-4594
Mailing address
1027 CANTERBURY DR, PONTIAC, MI 48341-2337
(248) 904-3132
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PL1743888
LIABILITY INSURANCE
—
Enumeration date
07/19/2018
Last updated
07/19/2018
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