Individual
ELENITA MANDILAG CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
900 S BEACON BLVD, GRAND HAVEN, MI 49417-2146
(616) 846-1850
Mailing address
14745 MERCURY DR, GRAND HAVEN, MI 49417-9703
(973) 960-1216
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501013549
MI
Other
Enumeration date
04/10/2018
Last updated
04/10/2018
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