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Individual

BRENDA KAY MOULTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
926 HIGH ST, CHARLOTTE, MI 48813-1254
(517) 213-6329
Mailing address
530 BEECH ST, CHARLOTTE, MI 48813-1016

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501003996
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
5501003996
LICENSE
MI
Enumeration date
02/27/2018
Last updated
02/27/2018
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