Registry details
Type
Individual
Primary specialty
Physical Therapist
Enumerated
Jun 12, 2025
License(s)
5501303986 (MI)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 412031 | Boston, MA 02241-2031 | 914-294-4050 |
| LOCATION | 2835 ORCHARD LAKE RD | Keego Harbor, MI 48320-1448 | 248-377-8220 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.