Healthcare Provider Details

I. General information

NPI: 1174859763
Provider Name (Legal Business Name): DAVID A BUURSMA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 01/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 WILSON AVE SW
GRANDVILLE MI
49418
US

IV. Provider business mailing address

PO BOX 30516 DEPT 5300
LANSING MI
48909
US

V. Phone/Fax

Practice location:
  • Phone: 616-855-1495
  • Fax: 616-847-1290
Mailing address:
  • Phone: 616-847-1280
  • Fax: 616-847-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501014838
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: