Provider Demographics
NPI:1619912714
Name:BIEDERBECK, JAMES D (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:BIEDERBECK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 DEWEY AVE NW
Mailing Address - Street 2:STE 300
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5283
Mailing Address - Country:US
Mailing Address - Phone:616-241-1809
Mailing Address - Fax:
Practice Address - Street 1:8354 100TH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CANADIAN LAKES
Practice Address - State:MI
Practice Address - Zip Code:49346-8333
Practice Address - Country:US
Practice Address - Phone:231-972-1040
Practice Address - Fax:231-972-1041
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010397225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5501010397OtherSTATE OF MICHIGAN
MI650G012500OtherBCBS
MI1649216144OtherGROUP NPI
MI1619912714OtherNPI
MI1649216144OtherGROUP NPI
MI0P04810Medicare PIN
MI650G012500OtherBCBS