Healthcare Provider Details

I. General information

NPI: 1871728816
Provider Name (Legal Business Name): HULST JEPSEN PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 43RD ST SE SUITE 100
GRAND RAPIDS MI
49508-3772
US

IV. Provider business mailing address

346 68TH ST SW
GRAND RAPIDS MI
49548-7179
US

V. Phone/Fax

Practice location:
  • Phone: 616-281-1144
  • Fax: 616-281-1221
Mailing address:
  • Phone: 616-281-1144
  • Fax: 616-281-1221

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: MRS. JEANNETTE REISTER
Title or Position: BILLING SPECIALIST
Credential:
Phone: 616-281-1144