| NPI | 1912541889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEY BROSSY Owner 313-216-0332 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery |
| 207XX0005X Orthopaedic Surgery Sports Medicine | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2019-11-04 |