Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Dec 29, 2025
License(s)
25351041201 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 36379 OLD HOMESTEAD DR | Farmington Hills, MI 48335-1267 | |
| LOCATION | 6777 W MAPLE RD | West Bloomfield, MI 48322-3013 | 248-325-1000 |
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