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General NPI Number Information
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NPI Number | 1164095907
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Entity Type | Individual
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Provider Name | TREVOR JON VANASSELT PTA
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Gender | Male
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Dates
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Enumeration Date | 07/20/2021
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Last Update Date | 07/20/2021
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Provider Practice Location Address
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Address Line | 29665 WILLIAM K SMITH DR
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City | NEW HUDSON
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State | MI
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Zip | 48165-8580
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Country | US
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Telephone | 517-420-8266
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Fax |
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Provider Business Mailing Address
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Address Line | 12881 TEN MILE RD
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City | SOUTH LYON
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State | MI
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Zip | 48178-9187
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Country | US
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Telephone | 248-982-3426
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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