Healthcare Provider Details

I. General information

NPI: 1245492305
Provider Name (Legal Business Name): PTI ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MICHIGAN ST
NEW BUFFALO MI
49117-1370
US

IV. Provider business mailing address

PO BOX 366
NEW BUFFALO MI
49117-0366
US

V. Phone/Fax

Practice location:
  • Phone: 269-470-4200
  • Fax: 574-822-1108
Mailing address:
  • Phone: 269-470-4200
  • Fax: 574-822-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. EDWARD ZIESMER
Title or Position: PRESIDENT
Credential: PT MS
Phone: 269-470-4200