Individual
MRS. HOLLY ERIN BANNINGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
Mailing address
1471 GRACE ST SE, GRAND RAPIDS, MI 49506-1678
(616) 913-2006
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
L2091952
MI
Other
Enumeration date
08/09/2012
Last updated
08/09/2012
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