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General NPI Number Information
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NPI Number | 1508318296
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Entity Type | Organization
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Legal Business Name | ENDURANCE REHABILITATION & ATHLETICS PLLC
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 12/12/2016
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Provider Practice Location Address
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Address Line | 6440 FULTON ST E SUITE 150
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City | ADA
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State | MI
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Zip | 49301-8449
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Country | US
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Telephone | 616-307-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 6440 FULTON ST E SUITE 150
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City | ADA
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State | MI
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Zip | 49301-8449
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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 | MR. ADAM EDWIN HOMOLKA
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Credential | MPT
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Telephone | 616-307-9950
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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 | 5501012622
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 5501012622
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 5501012622
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License Number State | MI
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