Healthcare Provider Details

I. General information

NPI: 1770126047
Provider Name (Legal Business Name): AARON LEE DOORN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2019
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 OAKS XING
PLAINWELL MI
49080-1916
US

IV. Provider business mailing address

231 TROWBRIDGE ST UNIT 2
ALLEGAN MI
49010-1306
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-9640
  • Fax: 269-685-9641
Mailing address:
  • Phone: 269-512-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501019290
License Number StateMI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: