Healthcare Provider Details

I. General information

NPI: 1497947618
Provider Name (Legal Business Name): PHYSIOTHERAPY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 08/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 616-844-1290
  • Fax: 616-844-1652
Mailing address:
  • Phone: 616-844-1290
  • Fax: 616-844-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROB ZIGENFUS
Title or Position: CONTRACTING
Credential:
Phone: 901-685-7227