Individual
JOUNI MANTYLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
10860 HIGHLAND RD, HARTLAND, MI 48353-2629
(810) 632-1000
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501005525
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00079943
RR MEDICARE
MI
01
—
P01352505
RAILROAD MEDICARE
MI
Enumeration date
12/08/2006
Last updated
10/10/2014
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