Individual
LETICIA LONGORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1055 FOREST HILL AVE SE, GRAND RAPIDS, MI 49546-3626
(616) 726-8595
Mailing address
5349 MARTIN RD, NORTON SHORES, MI 49441-5602
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502000900
MI
Other
Enumeration date
04/20/2026
Last updated
04/20/2026
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