Healthcare Provider Details

I. General information

NPI: 1003757725
Provider Name (Legal Business Name): MARISSA MCCANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 JEAN ST
YALE MI
48097-2932
US

IV. Provider business mailing address

7019 MELDRUM RD
IRA MI
48023-2427
US

V. Phone/Fax

Practice location:
  • Phone: 810-387-3226
  • Fax:
Mailing address:
  • Phone: 810-278-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008627
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: