Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501015081 | MI |
NPI | 1184185563 |
---|---|
Provider Name | Jill Coon |
First Address | Alto, MI 49302-8400 |
Second Address | Grand Rapids, MI 49504-3918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |