MEDICARE: ANTHONY BLAINE VANHORN PT, 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
1	225100000X	Physical Therapist	5501303588	MI

General Provider Information

NPI Number	:	1942024377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY BLAINE VANHORN PT, DPT

Provider Business Mailing Address
First Line	:	9368 N LILLEY RD
Second Line	:
City	:	PLYMOUTH
State	:	MI
Zip	:	48170-4610
Country	:	US
Telephone Number	:	734-416-3900
Fax Number	:	734-453-2118

Provider Business Practice Location Address
First Line	:	6012 LINDEN RD STE 15
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-8889
Country	:	US
Telephone Number	:	810-655-8244
Fax Number	:	810-655-2192

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

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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