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General NPI Number Information
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NPI Number | 1356525984
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Entity Type | Organization
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Legal Business Name | CROSWELL MANUAL THERAPY, INC
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 4990 N VAN DYKE
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City | KINDE
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State | MI
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Zip | 48445-0004
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Country | US
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Telephone | 989-874-4600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | KINDE
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State | MI
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Zip | 48445-0004
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Country | US
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Telephone | 989-874-4600
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. JONATHAN SISON DEL ROSARIO
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Credential | PHYSICAL THERAPIST
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Telephone | 810-404-8411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501007571
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License Number State | MI
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