| NPI | 1164682399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICK B FOUNTAIN Member 248-761-3530 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MI 5501010159) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: MI 5501010776) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |