Healthcare Provider Details

I. General information

NPI: 1649108762
Provider Name (Legal Business Name): EAGLE PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9339 MEADOWVIEW DR
DAVISON MI
48423-7808
US

IV. Provider business mailing address

9339 MEADOWVIEW DR
DAVISON MI
48423-7808
US

V. Phone/Fax

Practice location:
  • Phone: 810-287-5014
  • Fax:
Mailing address:
  • Phone: 810-287-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: PELLUMB KURTAGA
Title or Position: OWNER
Credential: PT,DPT
Phone: 810-287-5014