Healthcare Provider Details

I. General information

NPI: 1093068975
Provider Name (Legal Business Name): ERIC PAUL VERDIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE
JACKSON MI
49201-1852
US

IV. Provider business mailing address

4644 RIVES EATON RD
RIVES JUNCTION MI
49277-9651
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7633
  • Fax:
Mailing address:
  • Phone: 517-320-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502003560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: