Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist |
NPI | 1003046392 |
---|---|
Provider Name | Miss Namitha Konki |
First Address | Auburn Hills, MI 48326-4225 |
Second Address | Auburn Hills, MI 48326-4225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2009 |
Last Update Date | 21/07/2009 |