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NPI Code Detail

MEDICARE: GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C.

MEDICARE: GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C.
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 Therapist

General Provider Information

NPI Number : 1548764376
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C.
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2065
Fax Number :
Provider Business Practice Location Address
First Line : 9615 KEILMAN ST
Second Line :
City : SAINT JOHN
State : IN
Zip : 46373-9406
Country : US
Telephone Number : 219-365-0220
Fax Number : 219-365-0226
Authorized Official
Title or Position : PRESIDENT/CEO
Name : KEITH PITCHFORD
Credential :
Telephone Number : 219-365-0220
Provider Enumeration Date : 03/19/2018
Last Update Date : 04/13/2018

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Directions to “GREAT LAKES ORTHOPEDICS PHYSICAL THERAPY P.C. ” Practice Location

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