Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501020147 | MI |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1043749732 |
---|---|
Provider Name | Emily Marie Emerick |
First Address | White Plains, NY 10605-5224 |
Second Address | Coopersville, MI 49404-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2017 |
Last Update Date | 18/08/2021 |