Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501008220 | MI |
NPI | 1003194721 |
---|---|
Provider Name | Shelley Marie Poliner |
First Address | Easton, PA 18040-7958 |
Second Address | Brighton, MI 48116-2431 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 29/07/2011 |