Individual
GRACE ANN MCMICKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3921 LOCKPORT ST, BISMARCK, ND 58503-5541
(701) 751-3128
Mailing address
3921 LOCKPORT ST, BISMARCK, ND 58503-5541
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1539A
ND
Other
Enumeration date
11/05/2024
Last updated
11/05/2024
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