Healthcare Provider Details

I. General information

NPI: 1568614105
Provider Name (Legal Business Name): CASCADE PHYSICAL THERAPY & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 CASCADE RD SE STE E
GRAND RAPIDS MI
49546-3884
US

IV. Provider business mailing address

4930 CASCADE RD SE STE E
GRAND RAPIDS MI
49546-3884
US

V. Phone/Fax

Practice location:
  • Phone: 616-942-0922
  • Fax:
Mailing address:
  • Phone: 616-942-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name: SANJEEV THAMMAN
Title or Position: VICE PRESIDENT
Credential: MHS OTR
Phone: 616-942-0922