Individual
LARISSA L HEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4659 BLACKBURN AVE, PORTAGE, MI 49024-3045
(989) 327-7920
Mailing address
4659 BLACKBURN AVE, PORTAGE, MI 49024-3045
(989) 327-7920
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501001123
MI
Other
Enumeration date
01/12/2021
Last updated
01/12/2021
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