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NPI Code Detail

MEDICARE: NANCY MCKEON DUBUC PHYSICAL THERAPIST

MEDICARE: NANCY MCKEON DUBUC PHYSICAL THERAPIST
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
1225100000XPhysical Therapist5501009084MI

General Provider Information

NPI Number : 1407359342
Entity Type Code : Individual
Provider Name (Legal Business Name) : NANCY MCKEON DUBUC PHYSICAL THERAPIST
Provider Business Mailing Address
First Line : 14686 AMMERAAL AVE
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-9520
Country : US
Telephone Number : 616-402-9168
Fax Number :
Provider Business Practice Location Address
First Line : 900 S BEACON BLVD
Second Line :
City : GRAND HAVEN
State : MI
Zip : 49417-2146
Country : US
Telephone Number : 616-846-1850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2018
Last Update Date : 03/16/2018

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Directions to “ NANCY MCKEON DUBUC PHYSICAL THERAPIST” Practice Location

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