Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5501015130 | MI |
NPI | 1336705516 |
---|---|
Provider Name | Rommel Patrick Brown Cadorna |
First Address | Canton, MI 48188-2869 |
Second Address | Wayne, MI 48184-1485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2019 |
Last Update Date | 14/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501015130 | LARA , STATE OF MICHIGAN (01) |