Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 5501008959 | MI |
NPI | 1790115475 |
---|---|
Provider Name | Sandra Burns |
First Address | Rockford, MI 49341-1377 |
Second Address | Rockford, MI 49341-1377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 18/11/2013 |