MEDICARE: 616 PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1164233599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	616 PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	3669 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-2477
Country	:	US
Telephone Number	:	616-202-1872
Fax Number	:

Provider Business Practice Location Address
First Line	:	3669 PLAINFIELD AVE NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-2477
Country	:	US
Telephone Number	:	616-202-1872
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PT
Name	:	KARI CHAPPELL
Credential	:	PT
Telephone Number	:	616-745-7153

Provider Enumeration Date	:	01/15/2025
Last Update Date	:	01/15/2025

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