Provider Demographics
NPI:1659059913
Name:FLOURRY-REMBERT, DIERDRA DEE (LMMT)
Entity type:Individual
Prefix:MS
First Name:DIERDRA
Middle Name:DEE
Last Name:FLOURRY-REMBERT
Suffix:
Gender:F
Credentials:LMMT
Other - Prefix:MS
Other - First Name:DIERDRA
Other - Middle Name:DEE
Other - Last Name:FLOURRY-REMBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADS
Mailing Address - Street 1:5180 KALAMAZOO AVE SE STE CD
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4817
Mailing Address - Country:US
Mailing Address - Phone:616-717-2951
Mailing Address - Fax:616-805-3216
Practice Address - Street 1:5180 KALAMAZOO AVE SE STE CD
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4817
Practice Address - Country:US
Practice Address - Phone:616-717-2951
Practice Address - Fax:616-805-3216
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI104562-166-990-6876171100000X
MI7501014391172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No171100000XOther Service ProvidersAcupuncturist