Healthcare Provider Details

I. General information

NPI: 1144139288
Provider Name (Legal Business Name): LINH LY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 RAYBROOK ST SE STE 303
GRAND RAPIDS MI
49546-5783
US

IV. Provider business mailing address

155 WESTOWN DR NW APT 302
GRAND RAPIDS MI
49534-3713
US

V. Phone/Fax

Practice location:
  • Phone: 616-460-3834
  • Fax:
Mailing address:
  • Phone: 302-559-1874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008605
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: