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General NPI Number Information
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NPI Number | 1932602885
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Entity Type | Individual
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Provider Name | CRAIG ALLEN VISSERS MSPT
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Gender | Male
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Dates
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Enumeration Date | 03/16/2018
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 4868 LAKE MICHIGAN DR
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City | ALLENDALE
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State | MI
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Zip | 49401-8434
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Country | US
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Telephone | 616-391-7849
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Fax |
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Provider Business Mailing Address
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Address Line | 7725 BUCHANAN ST
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City | ALLENDALE
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State | MI
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Zip | 49401-9708
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Country | US
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Telephone |
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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 | 5501010842
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License Number State | MI
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