Provider Demographics
NPI:1730735341
Name:DOWD-ELLER, MIRIAM JOY (LMT)
Entity type:Individual
Prefix:MRS
First Name:MIRIAM
Middle Name:JOY
Last Name:DOWD-ELLER
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 1:2020 HOGBACK RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9752
Mailing Address - Country:US
Mailing Address - Phone:734-436-1177
Mailing Address - Fax:
Practice Address - Street 1:2020 HOGBACK RD STE 8
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9752
Practice Address - Country:US
Practice Address - Phone:734-436-1177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501008666225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist