Individual
JEANNE MARIE NYSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
23332 RED ARROW HWY, MATTAWAN, MI 49071-9703
(269) 283-5349
Mailing address
127 MARIGOLD AVE, PORTAGE, MI 49002-6251
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501002905
MI
Other
Enumeration date
07/19/2019
Last updated
07/19/2019
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