Individual
AMY-LYNN RUTH ELLENBERGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
311 W MITCHELL ST, PETOSKEY, MI 49770-2327
(231) 881-9012
(231) 881-9012
Mailing address
19260 3MILE HWY, ONAWAY, MI 49765
(231) 881-9012
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501010286
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7501010286
LMT LICENSE
MI
Enumeration date
10/24/2017
Last updated
10/24/2017
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