Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1501202 | MI |
NPI | 1508393059 |
---|---|
Provider Name | Mary Elaine Delgado |
First Address | Davison, MI 48423-3340 |
Second Address | Flint, MI 48507-2676 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 06/06/2017 |