Healthcare Provider Details

I. General information

NPI: 1477628386
Provider Name (Legal Business Name): JOSHUA SCHUELLER M.S.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 JUPITER AVE NE SUITE C
BELMONT MI
49306-8884
US

IV. Provider business mailing address

5060 CASCADE RD SE SUITE A
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-3290
  • Fax: 616-364-3299
Mailing address:
  • Phone: 616-954-0950
  • Fax: 616-954-1728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: