Healthcare Provider Details

I. General information

NPI: 1063930352
Provider Name (Legal Business Name): ALLISON HUYSER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date: 10/11/2017
Reactivation Date: 10/18/2017

III. Provider practice location address

4120 E BELTLINE AVE NE STE 200
GRAND RAPIDS MI
49525-9684
US

IV. Provider business mailing address

4120 E BELTLINE AVE NE STE 200
GRAND RAPIDS MI
49525-9684
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-2709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number60797387
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501018345
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: