Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501005926 | MI |
NPI | 1386113082 |
---|---|
Provider Name | Liyana A Chandrapala |
First Address | Canton, MI 48187-3533 |
Second Address | Canton, MI 48187-3533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2018 |
Last Update Date | 26/11/2018 |