Provider Demographics
NPI:1538761192
Name:STRONG, NANESHA (LMT, MMP)
Entity type:Individual
Prefix:
First Name:NANESHA
Middle Name:
Last Name:STRONG
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 CROOKS RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5506
Mailing Address - Country:US
Mailing Address - Phone:248-971-8309
Mailing Address - Fax:
Practice Address - Street 1:1890 CROOKS RD STE 140
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-5540
Practice Address - Country:US
Practice Address - Phone:248-971-8309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501003770225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist