Healthcare Provider Details

I. General information

NPI: 1205748936
Provider Name (Legal Business Name): NICHOLAS FRIEDLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 FULLER AVE NE
GRAND RAPIDS MI
49503-3675
US

IV. Provider business mailing address

7199 KALAMAZOO AVE SE STE 234
CALEDONIA MI
49316-7362
US

V. Phone/Fax

Practice location:
  • Phone: 616-608-8938
  • Fax:
Mailing address:
  • Phone: 616-608-9979
  • Fax: 616-608-9984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304728
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: