Healthcare Provider Details

I. General information

NPI: 1891947628
Provider Name (Legal Business Name): YVONNE BERNICE GARRISON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2008
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2775 E LANSING DR
EAST LANSING MI
48823-7755
US

IV. Provider business mailing address

2775 E LANSING DR
EAST LANSING MI
48823-7755
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-1616
  • Fax: 517-336-4797
Mailing address:
  • Phone: 517-332-1616
  • Fax: 517-336-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501004889
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: