Individual
TYWANA R COLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
25511 SOUTHFIELD RD STE 114, SOUTHFIELD, MI 48075-1830
(313) 205-6882
Mailing address
9178 LAKEPOINTE ST, DETROIT, MI 48224-2807
(313) 205-6882
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501009088
MI
Other
Enumeration date
08/23/2019
Last updated
08/23/2019
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