Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 5501001596 | MI |
Y | 2251N0400X | Physical Therapist - Neurology | 5501001596 | MI |
NPI | 1215439070 |
---|---|
Provider Name | Paul Sabourin |
First Address | Royal Oak, MI 48073 |
Second Address | Royal Oak, MI 48073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2018 |
Last Update Date | 07/03/2018 |