Individual
DARIS W BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
25688 W 12 MILE RD APT 104, SOUTHFIELD, MI 48034-8001
(313) 515-4133
Mailing address
25688 W 12 MILE RD APT 104, SOUTHFIELD, MI 48034-8001
(248) 340-3517
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501001766
MI
Other
Enumeration date
12/17/2021
Last updated
12/17/2021
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