Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501008894 | MI |
NPI | 1053889642 |
---|---|
Provider Name | Binu Gerald |
First Address | Ann Arbor, MI 48105-9335 |
Second Address | Ann Arbor, MI 48105-9335 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2018 |
Last Update Date | 13/11/2018 |