Individual
COREY BOLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
25336 TIMBER RIDGE TRL, BROWNSTOWN, MI 48134-1187
(734) 365-9805
Mailing address
25336 TIMBER RIDGE TRL, BROWNSTOWN, MI 48134-1187
(734) 365-9805
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502003626
MI
Other
Enumeration date
08/12/2012
Last updated
08/12/2012
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