| Organization Name: | LAKESHORE MASSAGE THERAPY INC |
| NPI Number: | 1851779763 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JANELLE REAVEY (OWNER) |
| Mailing Address: | 1845 Lakeshore Dr Suite 4 Muskegon |
| State: | MI US |
| Postal Code: | 494411896 |
| Phone Number: | 2317200969 |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2015 |
| NPI Last Update Date: | 05/12/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 7501001486 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |