Healthcare Provider Details

I. General information

NPI: 1144578964
Provider Name (Legal Business Name): CHRISTOPHER PATRICK MCCLOSKEY DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2012
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9028 N RODGERS CT SE SUITE J
CALEDONIA MI
49316-9786
US

IV. Provider business mailing address

2120 43RD ST SE SUITE 100
GRAND RAPIDS MI
49508-3772
US

V. Phone/Fax

Practice location:
  • Phone: 616-891-0600
  • Fax: 616-891-0660
Mailing address:
  • Phone: 616-281-1144
  • Fax: 616-281-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9941
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016632
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: