MEDICARE: STANTON CROSSINGS PHYSICAL THERAPY LLC

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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1609802313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANTON CROSSINGS PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	15151 STANTON ST
Second Line	:	SUITE B
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8543
Country	:	US
Telephone Number	:	616-296-9235
Fax Number	:	616-296-9236

Provider Business Practice Location Address
First Line	:	15151 STANTON ST
Second Line	:	SUITE B
City	:	WEST OLIVE
State	:	MI
Zip	:	49460-8543
Country	:	US
Telephone Number	:	616-296-9235
Fax Number	:	616-296-9236

Authorized Official
Title or Position	:	MEMBER
Name	:	STEVEN N DAVIDSON
Credential	:	PT
Telephone Number	:	61613455000

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	12/21/2007

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