Provider Demographics
NPI:1164676730
Name:3 DIMENSIONAL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:3 DIMENSIONAL PHYSICAL THERAPY, LLC
Other - Org Name:3D PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNCHION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-263-3378
Mailing Address - Street 1:1800 W US 223
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8439
Mailing Address - Country:US
Mailing Address - Phone:517-263-3378
Mailing Address - Fax:517-263-4527
Practice Address - Street 1:1800 W US 223
Practice Address - Street 2:SUITE 100
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-8439
Practice Address - Country:US
Practice Address - Phone:517-263-3378
Practice Address - Fax:517-263-4527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-10
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
MI261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1325Medicare PIN