Individual
KAWONNA PITTMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
15400 GRAND RIVER AVE, DETROIT, MI 48227-4124
(313) 758-8955
Mailing address
16048 HACKETT ST, DETROIT, MI 48227-1800
(313) 758-8955
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
06/03/2019
Last updated
06/03/2019
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