Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501019158 | MI |
NPI | 1063079390 |
---|---|
Provider Name | Marjeanne Bothma |
First Address | Midland, MI 48642-7062 |
Second Address | Midland, MI 48642-7062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2019 |
Last Update Date | 22/05/2019 |