Healthcare Provider Details

I. General information

NPI: 1689175218
Provider Name (Legal Business Name): RHODA MSACHI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4368 CLEVELAND AVE
STEVENSVILLE MI
49127-9595
US

IV. Provider business mailing address

2433 JEFFREY LN
NILES MI
49120-7706
US

V. Phone/Fax

Practice location:
  • Phone: 269-983-6501
  • Fax:
Mailing address:
  • Phone: 269-240-4744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502000807
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: