Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501013340 | MI |
NPI | 1033413612 |
---|---|
Provider Name | Mr. Pieter Nieuwenhuis |
First Address | Lake Linden, MI 49945-1220 |
Second Address | Lake Linden, MI 49945-1220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2010 |
Last Update Date | 22/12/2010 |