Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501008958 | MI |
NPI | 1346741089 |
---|---|
Provider Name | Leanne Clifton |
First Address | Davisburg, MI 48350-2611 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2018 |
Last Update Date | 27/02/2018 |