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General NPI Number Information
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NPI Number | 1679219638
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Entity Type | Individual
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Provider Name | THEODORE JAMES ST. JOHN DPT
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Gender | Male
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Dates
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Enumeration Date | 05/11/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 5866 MIDLAND RD
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City | FREELAND
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State | MI
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Zip | 48623-8707
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Country | US
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Telephone | 989-573-8588
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Fax | 989-573-8589
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Provider Business Mailing Address
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Address Line | 5866 MIDLAND RD
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City | FREELAND
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State | MI
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Zip | 48623-8707
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Country | US
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Telephone | 989-573-8588
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Fax | 989-573-8589
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5501301844
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License Number State | MI
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