Healthcare Provider Details

I. General information

NPI: 1750759874
Provider Name (Legal Business Name): AMIA A GAINES PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7402 WESTSHIRE DR STE 105
LANSING MI
48917-8687
US

IV. Provider business mailing address

7402 WESTSHIRE DR STE 105
LANSING MI
48917-8687
US

V. Phone/Fax

Practice location:
  • Phone: 517-853-6800
  • Fax: 517-853-6801
Mailing address:
  • Phone: 517-853-6800
  • Fax: 517-853-6801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberTX948229
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501302334
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: