Provider Demographics
NPI:1245834936
Name:PURPLE MOUNTAIN PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:PURPLE MOUNTAIN PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCHFIELD-O'KEEFE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:616-516-4334
Mailing Address - Street 1:847 PARCHMENT DR SE STE 101
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2303
Mailing Address - Country:US
Mailing Address - Phone:616-516-4334
Mailing Address - Fax:616-333-5311
Practice Address - Street 1:847 PARCHMENT DR SE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2303
Practice Address - Country:US
Practice Address - Phone:616-516-4334
Practice Address - Fax:616-333-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy