Healthcare Provider Details

I. General information

NPI: 1245834936
Provider Name (Legal Business Name): PURPLE MOUNTAIN PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2020
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 PARCHMENT DR SE STE 101
GRAND RAPIDS MI
49546-2303
US

IV. Provider business mailing address

847 PARCHMENT DR SE STE 101
GRAND RAPIDS MI
49546-2303
US

V. Phone/Fax

Practice location:
  • Phone: 616-516-4334
  • Fax: 616-333-5311
Mailing address:
  • Phone: 616-516-4334
  • Fax: 616-333-5311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAUREEN BLANCHFIELD-O'KEEFE
Title or Position: PHYSICAL THERAPIST
Credential: DPT
Phone: 616-516-4334