Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 5501018287 | MI |
NPI | 1013435643 |
---|---|
Provider Name | Samantha Wenson |
First Address | Clinton Township, MI 48038 |
Second Address | Clinton Township, MI 48038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2017 |
Last Update Date | 04/09/2017 |