Healthcare Provider Details

I. General information

NPI: 1992015671
Provider Name (Legal Business Name): LEE WILLIAM GARNER PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2010
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 MERIDIAN CROSSINGS SUITE 240
OKEMOS MI
48864-4584
US

IV. Provider business mailing address

3536 MERIDIAN CROSSINGS SUITE 240
OKEMOS MI
48864-4584
US

V. Phone/Fax

Practice location:
  • Phone: 517-347-2495
  • Fax: 517-347-3540
Mailing address:
  • Phone: 517-347-2495
  • Fax: 517-347-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000845
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: