Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501004151 | MI |
NPI | 1003150111 |
---|---|
Provider Name | Mrs. Gillian Deyoung |
First Address | Madison Heights, MI 48071-2109 |
Second Address | Warren, MI 48092-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 15/11/2012 |