Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502005527 | MI |
NPI | 1003378753 |
---|---|
Provider Name | Alexis Shivers |
First Address | Southfield, MI 48034 |
Second Address | Southfield, MI 48034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |