Healthcare Provider Details

I. General information

NPI: 1700138187
Provider Name (Legal Business Name): ASHLEY MARIE VANREES DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 W 72ND ST
NEWAYGO MI
49337-9800
US

IV. Provider business mailing address

4775 ALDUN RIDGE AVE NW APT 303
COMSTOCK PARK MI
49321-9066
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-8140
  • Fax: 231-652-8141
Mailing address:
  • Phone: 616-292-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501016098
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: