Individual
ANTHONY JOSEPH-LANE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6601 S LUCE AVE, FREMONT, MI 49412-7389
(231) 519-3559
Mailing address
6601 S LUCE AVE, FREMONT, MI 49412-7389
(231) 519-3559
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502005604
MI
225200000X
Physical Therapy Assistant
PTA.0014706
CO
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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