Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003319153 |
---|---|
Provider Name | Lana Spomer |
First Address | Troy, MI 48085-5079 |
Second Address | Troy, MI 48085-5079 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2018 |
Last Update Date | 07/07/2021 |