1629000799 NPI number — DAVENPORT & ASSOCIATES PHYSICAL THERAPY

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 1629000799 NPI number — DAVENPORT & ASSOCIATES PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVENPORT & ASSOCIATES PHYSICAL THERAPY
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:
1629000799
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LAKE POINTE CENTER
Provider Second Line Business Mailing Address:
882 S. GROVE RD. (UPPER SUITE)
Provider Business Mailing Address City Name:
YPSILANTI
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-483-1625
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
882 S. GROVE RD.
Provider Second Line Business Practice Location Address:
UPPER SUITE
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-483-1625
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVENPORT
Authorized Official First Name:
ALMA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PHYSICAL THERAPIST/CEO
Authorized Official Telephone Number:
734-483-1625

Provider Taxonomy Codes

  • Taxonomy code: 320700000X , with the licence number:  5501009797 , 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)

  • Identifier: 650H114050 . This is a "BLUE CROSS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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