Healthcare Provider Details

I. General information

NPI: 1235434952
Provider Name (Legal Business Name): AMY MARIE EASEY ASSOCIATES DEGREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3019 COIT AVE NE
GRAND RAPIDS MI
49505-3376
US

IV. Provider business mailing address

3019 COIT AVE NE
GRAND RAPIDS MI
49505-3376
US

V. Phone/Fax

Practice location:
  • Phone: 616-365-7761
  • Fax:
Mailing address:
  • Phone: 616-365-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001223
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: