Provider Demographics
NPI:1053830356
Name:GRDEN, ALLIE MICHELLE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:MICHELLE
Last Name:GRDEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24014 W RENWICK RD
Mailing Address - Street 2:STE F
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-8708
Mailing Address - Country:US
Mailing Address - Phone:800-974-4378
Mailing Address - Fax:630-515-1536
Practice Address - Street 1:3937 PATIENT CARE DR STE 105
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4287
Practice Address - Country:US
Practice Address - Phone:517-272-9320
Practice Address - Fax:517-272-9321
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist