Individual
DONNA JO WAGNITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7399 MIDDLEBELT RD STE 1, WEST BLOOMFIELD, MI 48322-4137
(248) 438-8443
Mailing address
4702 IRWINDALE DR, WATERFORD, MI 48328-2006
(248) 894-5870
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501011986
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
NA
—
Enumeration date
07/11/2021
Last updated
07/11/2021
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