Provider Demographics
NPI:1023238342
Name:MAYHEW, EARL EUGENE JR (DPT)
Entity type:Individual
Prefix:
First Name:EARL
Middle Name:EUGENE
Last Name:MAYHEW
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1602
Mailing Address - Country:US
Mailing Address - Phone:810-250-6112
Mailing Address - Fax:810-250-6113
Practice Address - Street 1:1365 N BELSAY RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1602
Practice Address - Country:US
Practice Address - Phone:810-250-6112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MI5501011353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N94450Medicare ID - Type Unspecified