Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1629577168 |
---|---|
Provider Name | Brenna Hammond |
First Address | Troy, MI 48084-2909 |
Second Address | Troy, MI 48084-2909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2018 |
Last Update Date | 11/02/2018 |