=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427376169
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOCUS ON FUNCTION PHYSICAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2010
-----------------------------------------------------
Last Update Date | 04/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 221 E A ST SUITE C
-----------------------------------------------------
City | IRON MOUNTAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49801-3462
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-779-9487
-----------------------------------------------------
Fax | 906-828-1473
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 706
-----------------------------------------------------
City | IRON MOUNTAIN
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49801-0706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 906-779-9487
-----------------------------------------------------
Fax | 906-828-1473
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST / PRESIDENT
-----------------------------------------------------
Name | COLLEEN A SLEIK
-----------------------------------------------------
Credential | PT, DPT, OCS, CEAS
-----------------------------------------------------
Telephone | 906-779-9487
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 5501012214
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------