| NPI | 1104393982 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELE WENINGER Credentialing Specialist 248-601-9207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2024-08-06 |