Provider Demographics
NPI:1609995349
Name:FINE, MICHAEL A (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:FINE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:14600 DRUMMOND RD
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9254
Mailing Address - Country:US
Mailing Address - Phone:419-447-7203
Mailing Address - Fax:419-447-5577
Practice Address - Street 1:70420 S. CENTERVILLE ROAD
Practice Address - Street 2:SUITE C
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091
Practice Address - Country:US
Practice Address - Phone:419-447-7203
Practice Address - Fax:419-447-5577
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501002566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist