Provider Demographics
NPI:1174859763
Name:BUURSMA, DAVID A (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:BUURSMA
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:18000 COVE STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SPRING LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49456-1383
Mailing Address - Country:US
Mailing Address - Phone:616-847-1280
Mailing Address - Fax:616-847-1290
Practice Address - Street 1:16140 148TH AVENUE
Practice Address - Street 2:SPRING LAKE COMMUNITY FITNESS & AQUATIC CENTER
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456
Practice Address - Country:US
Practice Address - Phone:616-847-1280
Practice Address - Fax:616-847-1290
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2014-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5501014838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP14760009Medicare PIN