Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501002942 | MI |
N | 2251N0400X | Physical Therapist - Neurology |
NPI | 1669965513 |
---|---|
Provider Name | Cheryl Trudeau |
First Address | Detroit, MI 48201-2495 |
Second Address | Detroit, MI 48201-2495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2018 |
Last Update Date | 14/06/2018 |