Provider Demographics
NPI:1144578964
Name:MCCLOSKEY, CHRISTOPHER PATRICK (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:PATRICK
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2120 43RD ST SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-3772
Mailing Address - Country:US
Mailing Address - Phone:616-281-1144
Mailing Address - Fax:616-281-1221
Practice Address - Street 1:9028 N RODGERS CT SE
Practice Address - Street 2:SUITE J
Practice Address - City:CALEDONIA
Practice Address - State:MI
Practice Address - Zip Code:49316-9786
Practice Address - Country:US
Practice Address - Phone:616-891-0600
Practice Address - Fax:616-891-0660
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ9941225100000X
MI5501016632225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ110609Medicare UPIN