Individual
BROOKE BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15400 NORTHLINE RD, SOUTHGATE, MI 48195-2689
(734) 285-0100
(734) 285-0101
Mailing address
33900 HARPER AVE STE 104, CLINTON TWP, MI 48035-4258
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502008669
MI
Other
Enumeration date
08/26/2024
Last updated
06/27/2025
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