Healthcare Provider Details

I. General information

NPI: 1952635302
Provider Name (Legal Business Name): GREAT LAKES THERAPY AT ORCHARD CREEK CAMPUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BARLOW ST
TRAVERSE CITY MI
49686-4721
US

IV. Provider business mailing address

9731 E CHERRY BEND RD
TRAVERSE CITY MI
49684-7621
US

V. Phone/Fax

Practice location:
  • Phone: 231-941-3100
  • Fax:
Mailing address:
  • Phone: 231-929-8180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMES A HARVEY
Title or Position: PHYSICAL THERAPIST/OWNER
Credential: MSPT
Phone: 231-642-6166