Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501010505 | MI |
NPI | 1053733469 |
---|---|
Provider Name | Mr. Paul Jankowski |
First Address | Livonia, MI 48152-1411 |
Second Address | Livonia, MI 48152-1411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2014 |
Last Update Date | 21/01/2014 |