Provider Demographics
NPI:1124417589
Name:ALDERINK, MARTI J (DPT)
Entity Type:Individual
Prefix:
First Name:MARTI
Middle Name:J
Last Name:ALDERINK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARTI
Other - Middle Name:J
Other - Last Name:ALDERINK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:235 WEALTHY ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-5247
Mailing Address - Country:US
Mailing Address - Phone:616-840-8000
Mailing Address - Fax:
Practice Address - Street 1:7550 W EMERALD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9015
Practice Address - Country:US
Practice Address - Phone:208-375-0666
Practice Address - Fax:208-375-2996
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017519225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist