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Organization
SPINE AND EXTREMITY INSTITUTE OF SOUTH LYON, L.L.C.
Active
Organization
SPINE AND EXTREMITY INSTITUTE OF SOUTH LYON, L.L.C.
Active
Other names
Brostrom Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW ALEXANDER BROSTROM MPT, CERT. MDT (OWNER/DIRECTOR OF PHYSICAL THERAPY)
(248) 446-0155
Entity
Organization
Contact information
Practice address
22180 PONTIAC TRAIL, SUITE E, SOUTH LYON, MI 48178-9097
(248) 446-0155
(248) 446-0177
Mailing address
22180 PONTIAC TRAIL, SUITE E, SOUTH LYON, MI 48178-9097
(248) 446-0155
(248) 446-0177
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501010651
MI
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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