Provider Demographics
NPI:1336012830
Name:BRUMMETTE, MARCIE ANN (LMT)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:ANN
Last Name:BRUMMETTE
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 1:342 E PEARL ST
Mailing Address - Street 2:
Mailing Address - City:POTTERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48876-9792
Mailing Address - Country:US
Mailing Address - Phone:517-652-4862
Mailing Address - Fax:
Practice Address - Street 1:432 N COCHRAN AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-1126
Practice Address - Country:US
Practice Address - Phone:517-543-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501017132225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist