Provider Demographics
NPI:1285209833
Name:WELLNESS MASSAGE AND INTEGRATED THERAPIES PLLC
Entity type:Organization
Organization Name:WELLNESS MASSAGE AND INTEGRATED THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BARENSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-796-4347
Mailing Address - Street 1:1041 E 16TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-9173
Mailing Address - Country:US
Mailing Address - Phone:616-710-1851
Mailing Address - Fax:
Practice Address - Street 1:675 E 16TH ST STE 55
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-5807
Practice Address - Country:US
Practice Address - Phone:616-796-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty