1225154834 NPI number — MARQUETTE ORTHOPEDIC AND SPORTS THERAPY INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225154834 NPI number — MARQUETTE ORTHOPEDIC AND SPORTS THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARQUETTE ORTHOPEDIC AND SPORTS THERAPY INC.
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:
Provider Other Organization Name Type Code:
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:
1225154834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1007 HARBOR HILLS DR
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MARQUETTE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49855-8859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-225-5585
Provider Business Mailing Address Fax Number:
906-225-5990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1007 HARBOR HILLS DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MARQUETTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49855-8859
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-225-5585
Provider Business Practice Location Address Fax Number:
906-225-5990
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KERRY
Authorized Official First Name:
KURT
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT P.T./CLINIC OWNER
Authorized Official Telephone Number:
906-225-5585

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5501005513 , 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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