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General NPI Number Information
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NPI Number | 1861561862
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Entity Type | Individual
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Provider Name | CONSTANCE LADAY DINNER P.T., C.L.T.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 748 SOUTH MAIN ST CHEBOYGAN MEMORIAL HOSPITAL, REHABILITATION SERVICES
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City | CHEBOYGAN
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State | MI
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Zip | 49721
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Country | US
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Telephone | 231-627-1252
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Fax | 231-627-1305
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Provider Business Mailing Address
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Address Line | 2038 MAPLE GROVE RD
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City | CHEBOYGAN
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State | MI
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Zip | 49721-9018
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Country | US
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Telephone | 231-597-9303
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Fax |
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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 | 5501000980
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License Number State | MI
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