Individual
LACI DAWN JOHNCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2786 56TH STREET, WYOMING, MI 49418
(616) 261-3960
(616) 261-3925
Mailing address
11252 SPRAGUE ROAD, DELTON, MI 49046
(269) 365-8090
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502003277
MI
Other
Enumeration date
08/05/2015
Last updated
08/05/2015
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