Provider Demographics
NPI:1740616499
Name:KALAMAZOO ATHLETIC WELLNESS LLC
Entity Type:Organization
Organization Name:KALAMAZOO ATHLETIC WELLNESS LLC
Other - Org Name:KALAMAZOO ATHLETIC WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:GARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:269-870-0156
Mailing Address - Street 1:200 TURWILL LN
Mailing Address - Street 2:STE 102
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4277
Mailing Address - Country:US
Mailing Address - Phone:269-870-0156
Mailing Address - Fax:
Practice Address - Street 1:200 TURWILL LN
Practice Address - Street 2:STE 102
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-4277
Practice Address - Country:US
Practice Address - Phone:269-870-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501001033172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172M00000XOther Service ProvidersMechanotherapistGroup - Single Specialty