Individual
MR. GLENN LUDGATE FITKIN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
(616) 252-7199
Mailing address
5900 BYRON CENTER AVE SW, WYOMING, MI 49519-9606
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501020251
MI
Other
Enumeration date
01/21/2022
Last updated
01/21/2022
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