Provider Demographics
NPI:1558646109
Name:NORTHERN MICHIGAN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NORTHERN MICHIGAN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUMB
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, OCS, MT(ASCP)
Authorized Official - Phone:906-630-1153
Mailing Address - Street 1:1001 M 28 E STE 8
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-9322
Mailing Address - Country:US
Mailing Address - Phone:906-630-1153
Mailing Address - Fax:
Practice Address - Street 1:1001 M 28 E STE 8
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-9322
Practice Address - Country:US
Practice Address - Phone:906-630-1153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501013362261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy