MEDICARE: GLENDA KAY MAINES PT

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	5501002054	MI

General Provider Information

NPI Number	:	1801879531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA KAY MAINES PT

Provider Business Mailing Address
First Line	:	PO BOX 323
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836
Country	:	US
Telephone Number	:	517-223-8308
Fax Number	:	517-223-8344

Provider Business Practice Location Address
First Line	:	125 E GRAND RIVER AVE
Second Line	:
City	:	FOWLERVILLE
State	:	MI
Zip	:	48836-5137
Country	:	US
Telephone Number	:	517-223-8308
Fax Number	:	517-223-8344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/26/2012

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Directions to “ GLENDA KAY MAINES PT” Practice Location

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