Individual
KEITH RAYMOND MATHERLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MASSAGE THERAPIST
Contact information
Practice address
20000 VICTOR PKWY STE 100, LIVONIA, MI 48152-7027
(734) 953-1745
(734) 953-1743
Mailing address
20000 VICTOR PKWY STE 100, LIVONIA, MI 48152-7027
(734) 953-1745
(734) 953-1743
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501000863
MI
Other
Enumeration date
04/12/2018
Last updated
04/12/2018
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