Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 5502004344 | MI |
NPI | 1003213414 |
---|---|
Provider Name | Caylee Skvarenina |
First Address | Ludington, MI 49431-1568 |
Second Address | Ludington, MI 49431-1568 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 01/12/2014 |