Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501013839 | MI |
NPI | 1003060948 |
---|---|
Provider Name | Ancilla Walker |
First Address | Troy, MI 48084-3407 |
Second Address | West Bloomfield, MI 48323-3900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2008 |
Last Update Date | 30/03/2016 |