Healthcare Provider Details

I. General information

NPI: 1376775122
Provider Name (Legal Business Name): PROFESSIONAL SPECTRUM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 CHARTER DR SUITE 102
FLINT MI
48532-3589
US

IV. Provider business mailing address

1055 CHARTER DR SUITE 102
FLINT MI
48532-3589
US

V. Phone/Fax

Practice location:
  • Phone: 810-600-0000
  • Fax: 810-600-0002
Mailing address:
  • Phone: 810-600-0000
  • Fax: 810-600-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MS. VALENTINA M LOPEZ
Title or Position: OWNER PRESIDENT
Credential: RN
Phone: 810-600-0000