Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502004471 | MI |
NPI | 1013304492 |
---|---|
Provider Name | Amanda Theuerkorn |
First Address | Clinton Township, MI 48035-4258 |
Second Address | Livonia, MI 48154-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2015 |
Last Update Date | 23/04/2015 |