Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 5501012761 | MI |
NPI | 1184754822 |
---|---|
Provider Name | Daryl R Montie |
First Address | Rochester Hills, MI 48309-2028 |
Second Address | Ann Arbor, MI 48105-9755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 08/07/2007 |