Organization
640RX PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY LYNN GREGG-DUCHEMIN LMT (PRACTITIONER)
(231) 747-9163
Entity
Organization
Contact information
Practice address
400 N 3RD AVE, FRUITPORT, MI 49415-9774
(231) 747-9163
Mailing address
400 N 3RD AVE, FRUITPORT, MI 49415-9774
(231) 747-9163
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
—
—
225700000X
Massage Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501000434
MASSAGE LICENSE
MI
Enumeration date
03/05/2019
Last updated
09/21/2019
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