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NPI Code Detail

MEDICARE: COURTNEY LYNN FANKHAUSER CTRS

MEDICARE: COURTNEY LYNN FANKHAUSER CTRS
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
1225800000XRecreation Therapist59551

General Provider Information

NPI Number : 1558655001
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY LYNN FANKHAUSER CTRS
Provider Business Mailing Address
First Line : 2255 VIVIAN RD
Second Line :
City : MONROE
State : MI
Zip : 48162-4133
Country : US
Telephone Number : 419-367-3075
Fax Number :
Provider Business Practice Location Address
First Line : 10909 HANNAN RD
Second Line :
City : ROMULUS
State : MI
Zip : 48174-1383
Country : US
Telephone Number : 734-893-1080
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2011
Last Update Date : 08/26/2019

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