Individual
MR. BENJAMIN FODALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
3058 N STATE RD STE E, DAVISON, MI 48423-3508
(810) 652-6315
Mailing address
635 OLD FARM LN, LAPEER, MI 48446-2696
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501009186
MI
Other
Enumeration date
03/19/2018
Last updated
03/19/2018
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