Healthcare Provider Details

I. General information

NPI: 1497357974
Provider Name (Legal Business Name): TELEFOCUS PHYSICAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 BRONSON BLVD
KALAMAZOO MI
49008-3134
US

IV. Provider business mailing address

4030 BRONSON BLVD
KALAMAZOO MI
49008-3134
US

V. Phone/Fax

Practice location:
  • Phone: 269-464-0044
  • Fax: 844-906-2440
Mailing address:
  • Phone: 269-464-0044
  • Fax: 844-906-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MELISSA MAIDLOW BROWN
Title or Position: OWNER, PHYSICAL THERAPIST
Credential: MPT, DPT
Phone: 269-464-0044