Provider Demographics
NPI:1073377651
Name:VANDERHILL, MICAH SCOTT (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:SCOTT
Last Name:VANDERHILL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7107
Mailing Address - Country:US
Mailing Address - Phone:616-403-6247
Mailing Address - Fax:
Practice Address - Street 1:160 W 33RD ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7107
Practice Address - Country:US
Practice Address - Phone:616-403-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist