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General NPI Number Information
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NPI Number | 1003253170
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Entity Type | Organization
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Legal Business Name | NORTHSPORT PHYSICAL THERAPY & REHABILITATION PC
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 11/05/2013
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Provider Practice Location Address
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Address Line | 1968 E MILLER RD
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City | FAIRVIEW
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State | MI
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Zip | 48621-8717
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Country | US
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Telephone | 989-848-2525
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Fax | 989-848-2999
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Provider Business Mailing Address
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Address Line | 1622 DICKERSON RD
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City | GAYLORD
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State | MI
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Zip | 49735-9206
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Country | US
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Telephone | 989-848-2525
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Fax | 989-848-2999
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Authorized Official
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Title or Position | PRESIDENT/PT
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Name | LISA C. PETRIE
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Credential | PT
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Telephone | 989-848-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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