Individual
TIMOTHY JAY ROE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2909 E GRAND RIVER AVE, LANSING, MI 48912-4300
(517) 364-8695
Mailing address
7982 DAWN DR, PORTLAND, MI 48875-1956
(517) 449-0192
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2601000184
MI
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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