Healthcare Provider Details

I. General information

NPI: 1760450373
Provider Name (Legal Business Name): JONATHAN W BILLINGS P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ATKINSON DR
LUDINGTON MI
49431-1906
US

IV. Provider business mailing address

1022 N SHERMAN ST
LUDINGTON MI
49431-1531
US

V. Phone/Fax

Practice location:
  • Phone: 231-299-0334
  • Fax: 231-845-2137
Mailing address:
  • Phone: 231-299-0334
  • Fax: 231-845-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number027807
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number5501009676
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: