Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501002898 | MI |
NPI | 1003148396 |
---|---|
Provider Name | Ann Leigh Macks |
First Address | Redford, MI 48239-3332 |
Second Address | Redford, MI 48239-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2010 |
Last Update Date | 11/02/2010 |