Individual
NICOLE MARIE GRATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
15132 LEVAN RD, LIVONIA, MI 48154-5027
(734) 462-1703
Mailing address
18415 FOCH ST, LIVONIA, MI 48152-3812
(248) 974-4646
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502005802
MI
Other
Enumeration date
01/06/2020
Last updated
01/06/2020
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