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General NPI Number Information
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NPI Number | 1134331689
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Entity Type | Organization
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Legal Business Name | KENTWOOD PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 05/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1423 60TH ST SE
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City | KENTWOOD
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State | MI
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Zip | 49508-7065
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Country | US
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Telephone | 616-446-9058
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Fax | 616-821-6162
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Provider Business Mailing Address
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Address Line | 1423 60TH ST SE
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City | KENTWOOD
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State | MI
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Zip | 49508-7065
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Country | US
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Telephone | 616-446-9058
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Fax | 616-821-6162
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Authorized Official
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Title or Position | CO-OWNER
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Name | ADAM B BEADENKOPF
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Credential | P.T.
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Telephone | 616-446-9058
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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 | 5501010446
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License Number State | MI
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