Healthcare Provider Details

I. General information

NPI: 1457570509
Provider Name (Legal Business Name): INDUSTRIAL ATHLETES IN MOTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 CASCADE RD SE SUITE A
GRAND RAPIDS MI
49546-3808
US

IV. Provider business mailing address

5060 CASCADE RD SE SUITE A
GRAND RAPIDS MI
49546-3808
US

V. Phone/Fax

Practice location:
  • Phone: 616-954-0950
  • Fax: 616-954-1728
Mailing address:
  • Phone: 616-954-0950
  • Fax: 616-954-1728

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: JEN PIECHOCKI
Title or Position: ACCOUNTING COORDINATOR
Credential:
Phone: 616-954-0950