Healthcare Provider Details

I. General information

NPI: 1942410931
Provider Name (Legal Business Name): MICHELLE TERRELL MS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 THREE MILE RD NW SUITE B
GRAND RAPIDS MI
49544
US

IV. Provider business mailing address

2339 ELDERWOOD DR NW
WALKER MI
49544-1711
US

V. Phone/Fax

Practice location:
  • Phone: 616-785-8535
  • Fax: 616-785-1201
Mailing address:
  • Phone: 616-785-8535
  • Fax: 616-785-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011156
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: