Healthcare Provider Details

I. General information

NPI: 1023489317
Provider Name (Legal Business Name): EMILY GUTHRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5990 VENTURE PARK DR
KALAMAZOO MI
49009-1858
US

IV. Provider business mailing address

4689 SALZBURG CIR
PORTAGE MI
49024-3041
US

V. Phone/Fax

Practice location:
  • Phone: 855-407-7575
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number004587
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005749
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: