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General NPI Number Information
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NPI Number | 1003576448
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Entity Type | Organization
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Legal Business Name | PRESCOTT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 12/27/2021
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Last Update Date | 12/27/2021
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Provider Practice Location Address
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Address Line | 311 E HARRISON ST
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City | PRESCOTT
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State | MI
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Zip | 48756-5135
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Country | US
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Telephone | 989-873-2540
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Fax | 989-873-2542
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | PRESCOTT
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State | MI
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Zip | 48756-0215
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Country | US
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Telephone | 989-873-2540
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHARON ISAAC
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Credential |
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Telephone | 989-873-2540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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