1093466195 NPI number — ALEXANDREA ESTHER AMBS DUNDORE DPT

Table of content: ALEXANDREA ESTHER AMBS DUNDORE DPT (NPI 1093466195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093466195 NPI number — ALEXANDREA ESTHER AMBS DUNDORE DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMBS DUNDORE
Provider First Name:
ALEXANDREA
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AMBS
Provider Other First Name:
ALEXANDREA
Provider Other Middle Name:
ESTER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093466195
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 KENMOOR AVE SE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-2395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
910 S US HIGHWAY 131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THREE RIVERS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49093-8802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-775-6030
Provider Business Practice Location Address Fax Number:
877-892-6252
Provider Enumeration Date:
01/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501301833 , 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)





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