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General NPI Number Information
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NPI Number | 1558632661
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Entity Type | Organization
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Legal Business Name | FREEDOM PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 01/20/2012
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 7885 BYRON CENTER AVE SW SUITE A
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City | BYRON CENTER
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State | MI
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Zip | 49315-8199
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Country | US
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Telephone | 616-277-1599
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Fax | 616-277-1626
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Provider Business Mailing Address
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Address Line | 7885 BYRON CENTER AVE SW SUITE A
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City | BYRON CENTER
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State | MI
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Zip | 49315-8199
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Country | US
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Telephone | 616-277-1599
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Fax | 616-277-1626
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Authorized Official
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Title or Position | OWNER
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Name | MR. DONALD HOWARD FREEHAFER JR.
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Credential | PT
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Telephone | 616-277-1599
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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 | 5501003194
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License Number State | MI
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