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General NPI Number Information
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NPI Number | 1366835811
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Entity Type | Organization
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Legal Business Name | NORTHPORT PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 03/09/2015
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Last Update Date | 03/09/2015
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Provider Practice Location Address
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Address Line | 301 N MILL ST
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City | NORTHPORT
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State | MI
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Zip | 49670-5009
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Country | US
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Telephone | 231-386-7147
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Fax |
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Provider Business Mailing Address
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Address Line | 9242 ORMES RD
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City | VASSAR
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State | MI
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Zip | 48768-9682
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Country | US
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Telephone | 989-652-0167
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Fax | 989-652-0167
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Authorized Official
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Title or Position | OWNER
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Name | THERESA MARY MADAY
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Credential | PT, DPT
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Telephone | 989-652-0167
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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 | 5501003462
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License Number State | MI
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