Healthcare Provider Details

I. General information

NPI: 1578561395
Provider Name (Legal Business Name): RON BRICKEY ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 WATER ST STE 2
PORT HURON MI
48060-4408
US

IV. Provider business mailing address

1037 WATER ST STE 2
PORT HURON MI
48060-4408
US

V. Phone/Fax

Practice location:
  • Phone: 810-982-9541
  • Fax: 810-982-5349
Mailing address:
  • Phone: 810-982-9541
  • Fax: 810-982-5349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. SCOTT BRICKEY
Title or Position: MANAGER
Credential:
Phone: 810-982-9541