Individual
ICELLE GRACE VILLANUEVA MARTINEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
36313 ST ANDREWS DR, LIVONIA, MI 48152-4130
(248) 805-2622
Mailing address
36313 ST ANDREWS DR, LIVONIA, MI 48152-4130
(248) 805-2622
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
5501012216
MI
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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