MEDICARE: HARBOR SPRINGS THERAPY AND WELLNESS

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	225100000X	Physical Therapist	5501011595	MI

General Provider Information

NPI Number	:	1770959728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARBOR SPRINGS THERAPY AND WELLNESS

Provider Business Mailing Address
First Line	:	3277 NEEDLES DR
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8796
Country	:	US
Telephone Number	:	231-838-2087
Fax Number	:

Provider Business Practice Location Address
First Line	:	3277 NEEDLES DR
Second Line	:
City	:	HARBOR SPRINGS
State	:	MI
Zip	:	49740-8796
Country	:	US
Telephone Number	:	231-838-2087
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAMON CRAIG WHITFIELD
Credential	:	PT
Telephone Number	:	231-838-2087

Provider Enumeration Date	:	08/13/2015
Last Update Date	:	10/16/2015

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