Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501011216 | MI |
NPI | 1033611819 |
---|---|
Provider Name | Amber Jean Daman |
First Address | Caledonia, MI 49316-9200 |
Second Address | Grand Rapids, MI 49508-3605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501011216 | (05) | MI |