Healthcare Provider Details

I. General information

NPI: 1780814715
Provider Name (Legal Business Name): JUDITH CLARE BIRKMEIER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JUDITH CLARE WAY P.T

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6016 LOVERS LN STE 3
PORTAGE MI
49002-3050
US

IV. Provider business mailing address

6016 LOVERS LN STE 3
PORTAGE MI
49002-3050
US

V. Phone/Fax

Practice location:
  • Phone: 269-329-0934
  • Fax: 269-329-0965
Mailing address:
  • Phone: 269-329-0934
  • Fax: 269-329-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501003445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: