Healthcare Provider Details

I. General information

NPI: 1932603768
Provider Name (Legal Business Name): ELIZABETH E UMLOR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2018
Last Update Date: 03/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CEDAR ST NE
GRAND RAPIDS MI
49503-1375
US

IV. Provider business mailing address

7200 LARNED DR NE
BELDING MI
48809-9373
US

V. Phone/Fax

Practice location:
  • Phone: 616-486-3900
  • Fax:
Mailing address:
  • Phone: 616-819-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501005268
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: