Healthcare Provider Details

I. General information

NPI: 1417183971
Provider Name (Legal Business Name): AGILITY HEALTH REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 DEWEY AVE NW SUITE 300
GRAND RAPIDS MI
49504-7335
US

IV. Provider business mailing address

607 DEWEY AVE NW SUITE 300
GRAND RAPIDS MI
49504-7335
US

V. Phone/Fax

Practice location:
  • Phone: 616-356-5000
  • Fax: 616-356-5001
Mailing address:
  • Phone: 616-356-5000
  • Fax: 616-356-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. STEVEN N DAVIDSON
Title or Position: CEO
Credential: PT
Phone: 616-356-5000