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General NPI Number Information
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NPI Number | 1245834936
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Entity Type | Organization
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Legal Business Name | PURPLE MOUNTAIN PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 11/24/2020
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 847 PARCHMENT DR SE STE 101
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2303
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Country | US
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Telephone | 616-516-4334
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Fax | 616-333-5311
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Provider Business Mailing Address
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Address Line | 847 PARCHMENT DR SE STE 101
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2303
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Country | US
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Telephone | 616-516-4334
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Fax | 616-333-5311
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. MAUREEN BLANCHFIELD-O'KEEFE
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Credential | DPT
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Telephone | 616-516-4334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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