Provider Demographics
NPI:1245832518
Name:DAVID, JOSIE LYNNE (ATC)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:LYNNE
Last Name:DAVID
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 CASCADE LAKES CIR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-6630
Mailing Address - Country:US
Mailing Address - Phone:616-916-7364
Mailing Address - Fax:
Practice Address - Street 1:771 CHESTNUT RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3434
Practice Address - Country:US
Practice Address - Phone:517-353-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty