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General NPI Number Information
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NPI Number | 1295995629
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Entity Type | Organization
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Legal Business Name | PHYSICAL THERAPY SERVICES OF GRAND RAPIDS, LLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 4070 LAKE DR SE SUITE: 204
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8294
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Country | US
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Telephone | 616-481-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 4070 LAKE DR SE SUITE: 204
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-8294
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Country | US
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Telephone | 616-481-3690
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MS. KATHY LOU CARRIER
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Credential | PT
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Telephone | 616-481-3690
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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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