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General NPI Number Information
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NPI Number | 1558646109
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Entity Type | Organization
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Legal Business Name | NORTHERN MICHIGAN PHYSICAL THERAPY
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 1001 M 28 E STE 8
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City | MARQUETTE
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State | MI
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Zip | 49855-9322
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Country | US
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Telephone | 906-630-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 M 28 E STE 8
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City | MARQUETTE
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State | MI
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Zip | 49855-9322
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Country | US
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Telephone | 906-630-1153
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID COLUMB
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Credential | DPT, OCS, MT(ASCP)
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Telephone | 906-630-1153
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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 | 5501013362
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License Number State | MI
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