MEDICARE: JIM DUSENBERRY PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	5502004085	MI

General Provider Information

NPI Number	:	1063266500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM DUSENBERRY PTA

Provider Business Mailing Address
First Line	:	3320 GERMAINE RD
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4199
Country	:	US
Telephone Number	:	231-670-9677
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 GERMAINE RD
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49441-4199
Country	:	US
Telephone Number	:	231-750-8480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/12/2024

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Directions to “ JIM DUSENBERRY PTA” Practice Location

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