1295092658 NPI number — LEELANAU PHYSICAL THERAPY, PC

Table of content: (NPI 1295092658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295092658 NPI number — LEELANAU PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEELANAU PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LEELANAU PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295092658
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9578 WOODYS RUN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-7910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-933-9320
Provider Business Mailing Address Fax Number:
231-933-9320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1381 S WEST BAY SHORE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUTTONS BAY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49682-9498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-218-7056
Provider Business Practice Location Address Fax Number:
231-933-9320
Provider Enumeration Date:
04/23/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NOBLE
Authorized Official First Name:
AARON
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
231-357-1985

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501004763 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com