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NPI Code Detail

MEDICARE: GARRET WOERMAN DPT

MEDICARE: GARRET WOERMAN DPT
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 Therapist5501017441MI

General Provider Information

NPI Number : 1669841680
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARRET WOERMAN DPT
Provider Business Mailing Address
First Line : 3826 44TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3919
Country : US
Telephone Number : 616-554-0918
Fax Number : 616-554-3079
Provider Business Practice Location Address
First Line : 3826 44TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49512-3919
Country : US
Telephone Number : 616-554-0918
Fax Number : 616-554-3079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2015
Last Update Date : 09/21/2015

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