Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501008344 | MI |
NPI | 1174952766 |
---|---|
Provider Name | Beena Mathew |
First Address | East Lansing, MI 48823-9640 |
Second Address | Okemos, MI 48823 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2013 |
Last Update Date | 05/11/2013 |