Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501010685 | MI |
NPI | 1376816991 |
---|---|
Provider Name | Dr. Ida Marie Trott |
First Address | Fenton, MI 48430-9314 |
Second Address | Ann Arbor, MI 48105-2303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2012 |
Last Update Date | 05/11/2014 |