Provider Demographics
NPI:1992303168
Name:URSAN, NAOMI (LMT)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:URSAN
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 1:330 E MAPLE RD STE H
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2706
Mailing Address - Country:US
Mailing Address - Phone:248-795-5196
Mailing Address - Fax:
Practice Address - Street 1:330 E MAPLE RD STE H
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2706
Practice Address - Country:US
Practice Address - Phone:248-795-5196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIU625622015022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist