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General NPI Number Information
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NPI Number | 1548487093
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Entity Type | Organization
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Legal Business Name | HULST JEPSEN PHYSICAL THERAPY INC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4124 56TH ST SW SUITE 2
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City | WYOMING
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State | MI
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Zip | 49418-9494
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Country | US
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Telephone | 616-855-1495
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Fax | 616-855-1496
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Provider Business Mailing Address
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Address Line | 2120 43RD ST SE SUITE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-3772
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Country | US
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Telephone | 616-281-1144
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Fax | 616-281-1221
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Authorized Official
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Title or Position | PRESIDENT
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Name | THOMAS J HULST
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Credential | PT
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Telephone | 616-281-1144
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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 | 5501004694
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License Number State | MI
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