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NPI Code Detail

MEDICARE: LAKE ISABELLA PHYSICAL THERAPY, LLC

MEDICARE: LAKE ISABELLA PHYSICAL THERAPY, LLC
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
1225100000XPhysical Therapist5501014675MI
2225200000XPhysical Therapy Assistant5502003378MI
3225200000XPhysical Therapy Assistant5502001683MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11376811729OTHERMIPTAN MI5338
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376952853
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE ISABELLA PHYSICAL THERAPY, LLC
Provider Business Mailing Address
First Line : 50 N COLDWATER RD
Second Line : SUITE D
City : WEIDMAN
State : MI
Zip : 48893-8845
Country : US
Telephone Number : 989-546-7490
Fax Number : 989-546-7298
Provider Business Practice Location Address
First Line : 50 N COLDWATER RD
Second Line : SUITE D
City : WEIDMAN
State : MI
Zip : 48893-8845
Country : US
Telephone Number : 989-546-7490
Fax Number : 989-546-7298
Authorized Official
Title or Position : PRESIDENT, PT, DPT
Name : DR. SHANNON MARIE DEXTER
Credential : PT, DPT
Telephone Number : 989-546-7490
Provider Enumeration Date : 08/08/2014
Last Update Date : 08/08/2014

Similar Medicare Providers

1598084667 — SHANNON MARIE ROSKAMP PT, DPT, MSA
Practice Location Address:
50 N COLDWATER RD , SUITE D
WEIDMAN, MI
48893-8845
Practice Phone: 989-546-7490
Practice Fax: 989-546-7298
1376811729 — LAKE ISABELLA PHYSICAL THERAPY, LLC
Practice Location Address:
50 N COLDWATER RD , SUITE D
WEIDMAN, MI
48893-8845
Practice Phone: 989-546-7490
Practice Fax: 989-546-7298
1487994687 — KELLY BECHTEL PTA
Practice Location Address:
50 N COLDWATER RD STE D
WEIDMAN, MI
48893-8845
Practice Phone: 989-546-7490
Practice Fax: 989-546-7298
1790128122 — PATRICIA VONDOLOSKI
Practice Location Address:
50 N COLDWATER RD , SUITE D
WEIDMAN, MI
48893-8845
Practice Phone: 989-546-7490
Practice Fax: 989-546-7298
1245674407 — JENNIFER MOREY RAU
Practice Location Address:
50 N COLDWATER RD , SUITE D
WEIDMAN, MI
48893-8845
Practice Phone: 989-546-7490
Practice Fax: 989-546-7298
1316044613 — DR. HENRY PAUL SZELAG D.O.
Practice Location Address:
3520 NORTH WOODRUFF ROAD
WEIDMAN, MI
48893
Practice Phone: 989-644-3329
Practice Fax: 989-644-3724

Directions to “LAKE ISABELLA PHYSICAL THERAPY, LLC ” Practice Location

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