Individual
MARY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
15520 19 MILE RD STE 450, CLINTON TOWNSHIP, MI 48038-6332
(586) 416-2000
(586) 416-2013
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
(586) 350-2644
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502005859
MI
Other
Enumeration date
01/29/2020
Last updated
04/02/2026
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