Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501017070 | MI |
NPI | 1588054605 |
---|---|
Provider Name | Luiza Fernandes Iervolino Lemerise |
First Address | Auburn Hills, MI 48326-2030 |
Second Address | Clinton Township, MI 48038-1656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2015 |
Last Update Date | 06/04/2016 |