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General NPI Number Information
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NPI Number | 1780142471
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Entity Type | Organization
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Legal Business Name | MINDSETPT LLC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 6955 W Q AVE
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City | KALAMAZOO
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State | MI
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Zip | 49009-8942
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Country | US
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Telephone | 269-301-0862
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Fax | 269-525-2331
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Provider Business Mailing Address
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Address Line | 10926 PAW PAW LAKE DR
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City | SCHOOLCRAFT
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State | MI
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Zip | 49087-9436
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Country | US
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Telephone | 248-361-9693
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Fax | 269-525-2331
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | ELLEN W HECTOR
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Credential | PT, DPT, COMT, ITPT
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Telephone | 248-361-9693
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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 |
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License Number State |
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