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General NPI Number Information
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NPI Number | 1275272247
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Entity Type | Individual
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Provider Name | MICHAELA MAGRY PTA
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Gender | Female
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 148 S MAIN ST
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City | LESLIE
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State | MI
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Zip | 49251-2561
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Country | US
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Telephone | 517-589-9050
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Fax | 517-589-9059
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Provider Business Mailing Address
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Address Line | 4480 WILLOUGHBY RD
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City | HOLT
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State | MI
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Zip | 48842-9413
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Country | US
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Telephone | 248-220-3510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 5502005375
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License Number State | MI
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