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General NPI Number Information
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NPI Number | 1336872571
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Entity Type | Organization
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Legal Business Name | STAY WELL SPORTS
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 4350 CONCOURSE DR
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City | ANN ARBOR
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State | MI
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Zip | 48108-9687
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Country | US
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Telephone | 765-749-1680
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Fax |
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Provider Business Mailing Address
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Address Line | 4350 CONCOURSE DR
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City | ANN ARBOR
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State | MI
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Zip | 48108-9687
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICIA DARLAND
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Credential | PT,DPT
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Telephone | 765-749-1680
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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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