Individual
TRAVIS JOHN DEKRUYTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
22818 LODGE LN, DEARBORN, MI 48128-1811
(313) 600-8124
Mailing address
22818 LODGE LN, DEARBORN, MI 48128-1811
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
05/17/2016
Last updated
05/17/2016
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