Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501004095 | MI |
NPI | 1346719994 |
---|---|
Provider Name | Donna Lenore Ferrell |
First Address | Livonia, MI 48154-3866 |
Second Address | Livonia, MI 48154-3866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2018 |
Last Update Date | 13/11/2018 |