Individual
AXALAN G AXALAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICAL THERAPIST
Contact information
Practice address
26001 JEFFERSON AVE, SAINT CLAIR SHORES, MI 48081-2309
(586) 779-7000
Mailing address
2630 UNION LAKE RD, COMMERCE TOWNSHIP, MI 48382-3582
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501014604
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5501014604
—
MI
Enumeration date
05/16/2018
Last updated
06/16/2018
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