Provider Demographics
NPI:1972851939
Name:DELONG, JANET RABBITT (PT)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:RABBITT
Last Name:DELONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:DELONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1471 GRACE ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-1678
Mailing Address - Country:US
Mailing Address - Phone:616-913-2006
Mailing Address - Fax:616-913-2005
Practice Address - Street 1:1471 GRACE ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-1678
Practice Address - Country:US
Practice Address - Phone:616-913-2006
Practice Address - Fax:616-913-2005
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002026225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist