Active NPI
Andre Lately
- Massage Therapist
- Redford, MI
National Provider Identifier
1689941783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- Practice address
- 27003 Plymouth Rd
Redford, MI 48239-2343 - Phone
- (313) 744-7055
- NPI assigned
- Nov 18, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | Primary |
Addresses
Primary practice location
27003 Plymouth Rd
Redford, MI 48239-2343
Mailing address
PO Box 4388
Detroit, MI 48204-0388
Phone (313) 516-5536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Massage Tea LC | Massage Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Massage Therapist
- Redford, MI
- NPI 1326315433
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1321574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321574400000",
"number": "1689941783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4388",
"city": "DETROIT",
"state": "MI",
"postal_code": "482040388",
"telephone_number": "313-516-5536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27003 PLYMOUTH RD",
"city": "REDFORD",
"state": "MI",
"postal_code": "482392343",
"telephone_number": "313-744-7055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LATELY",
"first_name": "ANDRE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-11-18",
"last_updated": "2011-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Redford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.