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General NPI Number Information
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NPI Number | 1104998319
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Entity Type | Organization
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Legal Business Name | HJL HOLDINGS, L.L.C.
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 3930 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-4634
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Country | US
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Telephone | 269-324-4333
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Fax | 269-324-4343
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Provider Business Mailing Address
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Address Line | 3930 W CENTRE AVE
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City | PORTAGE
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State | MI
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Zip | 49024-4634
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Country | US
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Telephone | 269-324-4333
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Fax | 269-324-4343
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. HARRY JOHN LEKOSIOTIS
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Credential | P.T.
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Telephone | 269-324-4333
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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 | 5501004512
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License Number State | MI
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