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General NPI Number Information
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NPI Number | 1013033604
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Entity Type | Organization
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Legal Business Name | CLINT VERRAN SPORTS MEDICINE, INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 1261 S LAPEER RD SUTIE 102
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City | LAKE ORION
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State | MI
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Zip | 48360-1419
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Country | US
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Telephone | 248-693-9411
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Fax | 248-693-9412
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Provider Business Mailing Address
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Address Line | 1261 S LAPEER RD SUITE 102
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City | LAKE ORION
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State | MI
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Zip | 48360-1419
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Country | US
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Telephone | 248-693-9411
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Fax | 248-693-9412
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Authorized Official
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Title or Position | OWNER
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Name | CLINT VERRAN
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Credential | PT
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Telephone | 248-693-9411
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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 | 5501010788
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License Number State | MI
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