| NPI | 1104033182 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | RONALD BROCKEY Physical Therapist 248-353-7507  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501001690)  | 
| Enumeration Date | 2007-05-17 | 
| Last Update Date | 2020-08-22 |