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General NPI Number Information
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NPI Number | 1558183541
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Entity Type | Organization
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Legal Business Name | LIVE WELL FITNESS AND PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 8575 S SHORE DR
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City | CLARKSTON
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State | MI
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Zip | 48348-2677
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Country | US
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Telephone | 248-514-0094
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Fax |
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Provider Business Mailing Address
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Address Line | 8575 SOUTH SHORE DR
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City | CLARKSTON
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State | MI
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Zip | 48348-2677
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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 | PHYSICAL THERAPIST
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Name | KATHRYN DUFFEY
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Credential | DPT
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Telephone | 248-514-0094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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