Individual
JEREMY DANIEL POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
23105 PROVIDENCE DR APT 316, SOUTHFIELD, MI 48075-3653
(805) 940-7153
Mailing address
23105 PROVIDENCE DR APT 316, SOUTHFIELD, MI 48075-3653
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501014893
MI
Other
Enumeration date
09/30/2022
Last updated
09/30/2022
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