Individual
KATIE ANN TENNISWOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2291 WATER ST STE 5, PORT HURON, MI 48060-2484
(810) 300-2948
Mailing address
4110 RABIDUE RD, CLYDE, MI 48049-2921
(810) 300-2948
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
7501014511
MI
Other
Enumeration date
04/07/2023
Last updated
04/07/2023
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