Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1356723795 |
---|---|
Provider Name | Elvin Verde |
First Address | Fennville, MI 49408-7604 |
Second Address | Fennville, MI 49408-7604 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 22/06/2015 |