1316494057 NPI number — BRITTANY SILVERTHORN DPT

Table of content: BRITTANY SILVERTHORN DPT (NPI 1316494057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316494057 NPI number — BRITTANY SILVERTHORN DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERTHORN
Provider First Name:
BRITTANY
Provider Middle Name:
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:
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:
1316494057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4761 LAKE MICHIGAN DR NW
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49534-6300
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:
9028 N RODGERS DR
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
CALEDONIA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49316-9786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-890-0600
Provider Business Practice Location Address Fax Number:
616-891-0660
Provider Enumeration Date:
09/09/2016

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:  5501017860 , 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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