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General NPI Number Information
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NPI Number | 1326993924
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Entity Type | Organization
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Legal Business Name | FUEL HEALTH & WELLNESS - GRANDVILLE, PLLC
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Dates
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Enumeration Date | 02/28/2026
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Last Update Date | 02/28/2026
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Provider Practice Location Address
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Address Line | 4693 WILSON AVE SW STE K
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City | GRANDVILLE
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State | MI
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Zip | 49418-8762
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Country | US
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Telephone | 616-757-0932
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Fax |
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Provider Business Mailing Address
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Address Line | 4693 WILSON AVE SW STE K
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City | GRANDVILLE
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State | MI
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Zip | 49418-8762
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Country | US
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Telephone | 616-757-0932
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERIC SCOTT BROADWORTH
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Credential | PT, DPT, OCS
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Telephone | 810-347-5219
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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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