Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 5501016426 | MI |
NPI | 1003204371 |
---|---|
Provider Name | Todd Gerrit Cates |
First Address | Greenville, MI 48838 |
Second Address | Greenville, MI 48838 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2015 |
Last Update Date | 08/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30435 | BLUE CROSS BLUE SHIELD (01) | MI |