Provider Demographics
NPI:1598153611
Name:PHYSIOTHERAPY ASSOCIATES
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:DARCANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:616-617-7932
Mailing Address - Street 1:8380 45TH ST SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9227
Mailing Address - Country:US
Mailing Address - Phone:616-617-7932
Mailing Address - Fax:
Practice Address - Street 1:914 CHARLEVOIX DR STE 150
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-2294
Practice Address - Country:US
Practice Address - Phone:517-627-9292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501017029261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy