Individual
MR. WAYNE PARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
27850 GRATIOT AVE, ROSEVILLE, MI 48066-4803
(586) 772-5876
Mailing address
57232 NEWPORT LN, WASHINGTON, MI 48094-3033
(586) 275-8008
Taxonomy
Speciality
Code
Description
License number
State
172M00000X
Mechanotherapist
Primary
L581371
MI
Other
Enumeration date
03/23/2015
Last updated
03/23/2015
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