Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501012820 | MI |
NPI | 1073608907 |
---|---|
Provider Name | Mr. Jeffrey Sam Orow |
First Address | Walled Lake, MI 48390-1752 |
Second Address | West Bloomfield, MI 48322-3004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 07/12/2018 |