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Individual
MAR LU MONGCOPA MARTINEZ
Active
Individual
MAR LU MONGCOPA MARTINEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501013558
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5501013558
PT LICENSE
MI
Enumeration date
01/07/2020
Last updated
01/07/2020
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