Healthcare Provider Details

I. General information

NPI: 1295098945
Provider Name (Legal Business Name): IN HOME THERAPY OF GRAND RAPIDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 VALENTINE BLVD NE
GRAND RAPIDS MI
49525-3070
US

IV. Provider business mailing address

2433 VALENTINE BLVD NE
GRAND RAPIDS MI
49525-3070
US

V. Phone/Fax

Practice location:
  • Phone: 616-799-7891
  • Fax: 616-863-2030
Mailing address:
  • Phone: 616-799-7891
  • Fax: 616-863-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number5501010413
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY M BATT
Title or Position: MANAGER
Credential: PT
Phone: 616-799-7891