Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501006150 | MI |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1114429966 |
---|---|
Provider Name | Andrew Spencer Herner |
First Address | Ann Arbor, MI 48109-5000 |
Second Address | Ann Arbor, MI 48108-1605 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |