Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501016442 | MI |
NPI | 1003244799 |
---|---|
Provider Name | Erica Balsis |
First Address | Clinton Township, MI 48035-4258 |
Second Address | Livonia, MI 48152-2054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2013 |
Last Update Date | 19/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ON26170 | (02) | MI |