Provider Demographics
NPI:1942619523
Name:HUDSONVILLE PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:HUDSONVILLE PHYSICAL THERAPY, INC
Other - Org Name:LIVING HOPE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:616-662-0990
Mailing Address - Street 1:977 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-9800
Mailing Address - Country:US
Mailing Address - Phone:231-652-3860
Mailing Address - Fax:231-652-3861
Practice Address - Street 1:977 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-9800
Practice Address - Country:US
Practice Address - Phone:231-652-3860
Practice Address - Fax:231-652-3861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUDSONVILLE PHYSICAL THERAPY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-07
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002952261QP2000X
MI5501009001261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902977788Medicaid
MI236668Medicare Oscar/Certification