Provider Demographics
NPI:1497357974
Name:TELEFOCUS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:TELEFOCUS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MAIDLOW
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, DPT
Authorized Official - Phone:269-464-0044
Mailing Address - Street 1:4030 BRONSON BLVD
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-3134
Mailing Address - Country:US
Mailing Address - Phone:269-464-0044
Mailing Address - Fax:844-906-2440
Practice Address - Street 1:4030 BRONSON BLVD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-3134
Practice Address - Country:US
Practice Address - Phone:269-464-0044
Practice Address - Fax:844-906-2440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-10
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty