| NPI | 1225800972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELAINE RUSSETTE Credentialing COO Rdinator 586-552-4573 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2023-10-26 |