Individual
JOHANNA E MASTRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
23100 PROVIDENCE DR, SUITE 135, SOUTHFIELD, MI 48075-3646
(248) 905-5180
Mailing address
23100 PROVIDENCE DR, SUITE 135, SOUTHFIELD, MI 48075-3646
(248) 905-5180
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501011163
MI
Other
Enumeration date
09/24/2012
Last updated
09/24/2012
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