Individual
BEVERLY BAMBACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15870 N HAGGERTY RD, PLYMOUTH, MI 48170-4872
(734) 420-7917
Mailing address
17571 MCNAMARA DR, LIVONIA, MI 48152-3154
(734) 718-7239
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502002795
MI
Other
Enumeration date
01/03/2012
Last updated
01/03/2012
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