Healthcare Provider Details

I. General information

NPI: 1023643285
Provider Name (Legal Business Name): GINA E HOUTTEMAN PT, MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 E SLOCUM ST
WHITEHALL MI
49461-1199
US

IV. Provider business mailing address

18000 COVE ST STE 202
SPRING LAKE MI
49456-1383
US

V. Phone/Fax

Practice location:
  • Phone: 318-931-0772
  • Fax: 616-847-1290
Mailing address:
  • Phone: 616-847-1280
  • Fax: 616-847-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501010194
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: