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General NPI Number Information
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NPI Number | 1649480674
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Entity Type | Organization
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Legal Business Name | GREAT LAKES THERAPY HOUSE CALLS PC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 5123 N ROYAL DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-9201
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Country | US
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Telephone | 231-941-8100
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Fax | 231-941-8812
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Provider Business Mailing Address
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Address Line | 1650 BARLOW ST
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-4721
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Country | US
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Telephone | 231-941-8100
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Fax | 231-922-0382
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JAMES A HARVEY
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Credential | PT
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Telephone | 231-941-8100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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