Healthcare Provider Details

I. General information

NPI: 1477498525
Provider Name (Legal Business Name): ELIZABETH CYNTHIA ESCOBAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NILES AVE
SAINT JOSEPH MI
49085-1955
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 100
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 269-235-9192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304462
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: