Healthcare Provider Details

I. General information

NPI: 1992862221
Provider Name (Legal Business Name): MARISKA GEPFORD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 W HIGH ST
MT PLEASANT MI
48858-2242
US

IV. Provider business mailing address

1106 W HIGH ST
MT PLEASANT MI
48858-2242
US

V. Phone/Fax

Practice location:
  • Phone: 989-779-2920
  • Fax: 989-772-9424
Mailing address:
  • Phone: 989-779-2920
  • Fax: 989-772-9424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501007389
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: