1770880775 NPI number — PHYSIOTHERAPY ASSOCIATES, INC.

Table of content: (NPI 1770880775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770880775 NPI number — PHYSIOTHERAPY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSIOTHERAPY ASSOCIATES, 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:
1770880775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 COIT RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-3768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-467-8705
Provider Business Mailing Address Fax Number:
267-321-2550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 ROBBINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND HAVEN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49417-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-296-0845
Provider Business Practice Location Address Fax Number:
616-296-0845
Provider Enumeration Date:
02/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
POOL
Authorized Official First Name:
JAYNE
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
CHIEF COMPLIANCE OFFICER
Authorized Official Telephone Number:
469-467-8705

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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 © 2007-2025 www.npivalidator.com