Healthcare Provider Details

I. General information

NPI: 1538211925
Provider Name (Legal Business Name): ELK RAPIDS PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 04/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 AMES ST
ELK RAPIDS MI
49629-9739
US

IV. Provider business mailing address

128 AMES ST
ELK RAPIDS MI
49629-9739
US

V. Phone/Fax

Practice location:
  • Phone: 231-264-6682
  • Fax:
Mailing address:
  • Phone: 231-264-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003682
License Number StateMI

VIII. Authorized Official

Name: MRS. RHONDA BAKER LAMMERS
Title or Position: OWNER
Credential: P.T.
Phone: 231-264-6682