Healthcare Provider Details

I. General information

NPI: 1770684623
Provider Name (Legal Business Name): WEST MICHIGAN PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E TINKHAM AVE
LUDINGTON MI
49431-1536
US

IV. Provider business mailing address

901 E TINKHAM AVE
LUDINGTON MI
49431-1536
US

V. Phone/Fax

Practice location:
  • Phone: 231-843-2676
  • Fax: 231-843-2209
Mailing address:
  • Phone: 231-843-2676
  • Fax: 231-843-2209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number935864
License Number StateMI

VIII. Authorized Official

Name: DR. CAROLINE THERESE O'BRIEN
Title or Position: MEMBER
Credential: DPT
Phone: 231-843-2676