| NPI | 1205869880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICKY JOHN BASTARACHE President 810-694-1037 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501007536) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2020-08-22 |