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General NPI Number Information
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NPI Number | 1538499942
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Entity Type | Organization
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Legal Business Name | COOPERATIVE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 01/06/2010
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Last Update Date | 01/06/2010
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Provider Practice Location Address
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Address Line | 1935 SANDBURR DR
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City | JENISON
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State | MI
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Zip | 49428-9463
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Country | US
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Telephone | 616-608-7786
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Fax | 616-608-7786
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Provider Business Mailing Address
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Address Line | 1935 SANDBURR DR
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City | JENISON
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State | MI
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Zip | 49428-9463
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Country | US
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Telephone | 616-608-7786
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Fax | 616-608-7786
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Authorized Official
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Title or Position | SOLE PROPRIETER
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Name | MR. DAVID CHARLES PERRIN
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Credential | MSPT, ATC, CSCS
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Telephone | 616-608-7786
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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 | 5501010589
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License Number State | MI
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