Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501017552 | MI |
NPI | 1083115687 |
---|---|
Provider Name | Melissa Tye |
First Address | Detroit, MI 48236-2148 |
Second Address | Detroit, MI 48236-2148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 28/02/2018 |