| NPI | 1508318296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM EDWIN HOMOLKA Owner 616-307-9950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: MI 5501012622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501012622) |
| 2251S0007X Physical Therapist, Sports (Licence: MI 5501012622) | |
| Enumeration Date | 2016-10-27 |
| Last Update Date | 2016-12-12 |