Provider Demographics
NPI:1609802313
Name:STANTON CROSSINGS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:STANTON CROSSINGS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:6161-345-5000
Mailing Address - Street 1:15151 STANTON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WEST OLIVE
Mailing Address - State:MI
Mailing Address - Zip Code:49460-8543
Mailing Address - Country:US
Mailing Address - Phone:616-296-9235
Mailing Address - Fax:616-296-9236
Practice Address - Street 1:15151 STANTON ST
Practice Address - Street 2:SUITE B
Practice Address - City:WEST OLIVE
Practice Address - State:MI
Practice Address - Zip Code:49460-8543
Practice Address - Country:US
Practice Address - Phone:616-296-9235
Practice Address - Fax:616-296-9236
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGILITY HEALTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-24
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty