Provider Demographics
NPI:1124685854
Name:TRANQUILL, SHIRLEY JEAN (LMT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JEAN
Last Name:TRANQUILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 SYLVAN RD
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:MI
Mailing Address - Zip Code:49635-8520
Mailing Address - Country:US
Mailing Address - Phone:231-399-0129
Mailing Address - Fax:231-399-0129
Practice Address - Street 1:345 SYLVAN RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:MI
Practice Address - Zip Code:49635-8520
Practice Address - Country:US
Practice Address - Phone:231-399-0129
Practice Address - Fax:231-399-0129
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501007726225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist