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General NPI Number Information
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NPI Number | 1508480005
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Entity Type | Organization
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Legal Business Name | FUNCTIONAL MOBILITY AND HEALTH, LLC
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Dates
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Enumeration Date | 06/01/2020
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Last Update Date | 06/01/2020
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Provider Practice Location Address
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Address Line | 13575 S AIRPORT RD
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City | LANSING
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State | MI
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Zip | 48906-9101
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Country | US
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Telephone | 517-819-4191
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Fax |
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Provider Business Mailing Address
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Address Line | 9249 W CUTLER RD
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City | EAGLE
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State | MI
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Zip | 48822-9726
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Country | US
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Telephone | 517-819-4191
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | KRISTI LEANNE STEPHENS
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Credential | AT, ATC, LMT, FNS
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Telephone | 517-819-4191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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