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Organization
MICHIGAN STATE UNIVERSITY
Active
Organization
MICHIGAN STATE UNIVERSITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RUCKER (ENROLLMENT & PATIENT ACCTS MANAGER)
(517) 355-8462
Entity
Organization
Contact information
Practice address
463 E CIRCLE DR, EAST LANSING, MI 48824-7500
(517) 355-4510
Mailing address
804 SERVICE RD # A109F, EAST LANSING, MI 48824-7015
(517) 884-2976
(517) 432-3928
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
09/08/2006
Last updated
04/05/2018
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