Healthcare Provider Details

I. General information

NPI: 1053360164
Provider Name (Legal Business Name): EILEEN PALAD RAMOS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E. GRAND RIVER
FOWLERVILLE MI
48836-0323
US

IV. Provider business mailing address

PO BOX 323 115 E. GRAND RIVER
FOWLERVILLE MI
48836-0323
US

V. Phone/Fax

Practice location:
  • Phone: 517-223-8308
  • Fax: 517-223-8344
Mailing address:
  • Phone: 517-223-8308
  • Fax: 517-223-8344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009516
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: