| NPI | 1518046598 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA M RUCKER Provider Enrollment Manager 517-355-8462 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: MI 5501007513) |
| Additional Taxonomies | 261QX0100X Clinic/Center, Occupational Medicine (Licence: MI 5201001302) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2018-04-05 |