Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501009975 | MI |
NPI | 1538660543 |
---|---|
Provider Name | Laura M Meengs |
First Address | Caledonia, MI 49316-8461 |
Second Address | Grand Rapids, MI 49503-5247 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2018 |
Last Update Date | 25/02/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437402542 | (05) | MI |