Provider Demographics
NPI:1306325253
Name:RESTORATIVE MASSAGE THERAPY
Entity type:Organization
Organization Name:RESTORATIVE MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPISTS
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:K
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:810-358-4336
Mailing Address - Street 1:4622 N LAKE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-8981
Mailing Address - Country:US
Mailing Address - Phone:810-358-4336
Mailing Address - Fax:
Practice Address - Street 1:105 E 2ND ST STE 2
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-1467
Practice Address - Country:US
Practice Address - Phone:810-510-0320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-11
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010623225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty