Provider Demographics
NPI:1669078903
Name:LAWERY, TAKERA A (LMT)
Entity type:Individual
Prefix:
First Name:TAKERA
Middle Name:A
Last Name:LAWERY
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 1:26150 5 MILE RD STE 1D
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-3244
Mailing Address - Country:US
Mailing Address - Phone:313-676-8889
Mailing Address - Fax:
Practice Address - Street 1:26150 5 MILE RD STE 1D
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-3244
Practice Address - Country:US
Practice Address - Phone:313-676-8889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501006887225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist