Healthcare Provider Details

I. General information

NPI: 1073045159
Provider Name (Legal Business Name): BRYAN FACE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 2ND ST
SPRING ARBOR MI
49283-9647
US

IV. Provider business mailing address

4437 S CICERO AVE
CHICAGO IL
60632-4333
US

V. Phone/Fax

Practice location:
  • Phone: 517-750-1900
  • Fax:
Mailing address:
  • Phone: 312-929-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502005165
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: