Most Relevant Information
Provider Data
| NPI Number: | 1003512385 |
| Provider Name: | RENISE MICKEY MT |
| Entity Type: | Individual |
| Taxonomy Code: | 225700000X |
| Specialty: | Massage Therapist |
| License Number: | MT21806622 |
Most Important Dates
| Enumeration Date: | 02/07/2023 |
| Last Updated: | 02/07/2023 |
Provider Practice Location
9219 INDIANAPOLIS BLVD STE 204
HIGHLAND
IN
463222573
Practice Location Phone/Fax
| Phone: | 2195016575 |
| Fax: |
Provider Mailing Location
7550 COLUMBIA AVE APT 5
HAMMOND
IN
463243059
Provider Mailing Phone/Fax
| Phone: | 2195016575 |
| Fax: |