Individual
EVAN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1505 OAKSHADE ST, #61, WALLED LAKE, MI 48390-2173
(248) 635-5256
Mailing address
1505 OAKSHADE ST, #61, WALLED LAKE, MI 48390-2173
(248) 635-5256
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502004814
MI
Other
Enumeration date
02/08/2016
Last updated
02/08/2016
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