Individual
IYESHA WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
24777 GREENFIELD RD, SOUTHFIELD, MI 48075-3065
(313) 363-8475
Mailing address
PO BOX 351, WARREN, MI 48090-0351
(313) 363-8475
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501005775
MI
Other
Enumeration date
11/13/2017
Last updated
11/13/2017
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