Individual
IZZAL THOMAS JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
23300 GREENFIELD RD, OAK PARK, MI 48237-5237
(734) 819-4023
Mailing address
18421 BRAILE ST, DETROIT, MI 48219-2507
(734) 819-4023
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501006832
MI
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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