Healthcare Provider Details

I. General information

NPI: 1417212507
Provider Name (Legal Business Name): HULST JEPSEN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE SUITE 160
GRAND RAPIDS MI
49546-3691
US

IV. Provider business mailing address

2120 43RD ST SE SUITE 100
GRAND RAPIDS MI
49508-3772
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-1215
  • Fax: 616-301-1217
Mailing address:
  • Phone: 616-281-1144
  • Fax: 616-281-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KAREN EMELANDER
Title or Position: BILLER
Credential:
Phone: 616-281-1144