MEDICARE: JOSEPH J LIBLONG

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	5501303836	MI

General Provider Information

NPI Number	:	1902601776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH J LIBLONG

Provider Business Mailing Address
First Line	:	854 WASHINGTON AVE STE 200
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7143
Country	:	US
Telephone Number	:	616-392-9430
Fax Number	:

Provider Business Practice Location Address
First Line	:	854 WASHINGTON AVE STE 200
Second Line	:
City	:	HOLLAND
State	:	MI
Zip	:	49423-7143
Country	:	US
Telephone Number	:	616-392-9430
Fax Number	:

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

Provider Enumeration Date	:	02/17/2025
Last Update Date	:	02/17/2025

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Directions to “ JOSEPH J LIBLONG ” Practice Location

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