Individual
JESSICA CECELIA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
31469 NEWPORT DR, WARREN, MI 48088-7041
(586) 536-0207
Mailing address
31469 NEWPORT DR, WARREN, MI 48088-7041
(586) 536-0207
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501015332
MI
Other
Enumeration date
03/20/2023
Last updated
03/20/2023
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