Provider Demographics
NPI:1851583074
Name:PHYSIOTHERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:PHYSIOTHERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIGENFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:84 E LAKEWOOD BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-2000
Mailing Address - Country:US
Mailing Address - Phone:616-392-7773
Mailing Address - Fax:616-392-9465
Practice Address - Street 1:84 E LAKEWOOD BLVD
Practice Address - Street 2:STE 104
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-2000
Practice Address - Country:US
Practice Address - Phone:616-392-7773
Practice Address - Fax:616-392-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2007-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236619Medicare Oscar/Certification