Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501005973 | MI |
NPI | 1326692187 |
---|---|
Provider Name | Pralay Patro |
First Address | Grosse Pointe Woods, MI 48236-1048 |
Second Address | Grosse Pointe Woods, MI 48236-1048 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2019 |
Last Update Date | 30/07/2019 |