Healthcare Provider Details

I. General information

NPI: 1609802313
Provider Name (Legal Business Name): STANTON CROSSINGS PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 STANTON ST SUITE B
WEST OLIVE MI
49460-8543
US

IV. Provider business mailing address

15151 STANTON ST SUITE B
WEST OLIVE MI
49460-8543
US

V. Phone/Fax

Practice location:
  • Phone: 616-296-9235
  • Fax: 616-296-9236
Mailing address:
  • Phone: 616-296-9235
  • Fax: 616-296-9236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN N DAVIDSON
Title or Position: MEMBER
Credential: PT
Phone: 61613455000