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General NPI Number Information
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NPI Number | 1023778693
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Entity Type | Organization
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Legal Business Name | PETOSKEY SPINE REHAB
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Dates
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Enumeration Date | 12/23/2021
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | 347 CREEKSIDE DR
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City | PETOSKEY
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State | MI
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Zip | 49770-8676
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Country | US
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Telephone | 231-420-0517
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Fax |
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Provider Business Mailing Address
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Address Line | 347 CREEKSIDE DR
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City | PETOSKEY
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State | MI
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Zip | 49770-8676
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. AMY DUBEY
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Credential | OTR/L
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Telephone | 231-420-0517
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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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