Provider Demographics
NPI:1124915152
Name:ROONEY, MIA L
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:L
Last Name:ROONEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 YORKSHIRE DR APT 23
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1055
Mailing Address - Country:US
Mailing Address - Phone:586-360-5259
Mailing Address - Fax:
Practice Address - Street 1:1510 YORKSHIRE DR APT 23
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1055
Practice Address - Country:US
Practice Address - Phone:586-360-5259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI750106863225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist