Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501011063 | MI |
NPI | 1730680059 |
---|---|
Provider Name | Amy Owen |
First Address | Flint, MI 48532-3638 |
Second Address | Flint, MI 48532-3638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 22/02/2018 |